Medical debt is associated with population health and increased mortality

Published

2 years ago

March 7, 2024

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By Dr. Sushama R. Chaphalkar, PhD. Mar 7 2024 Reviewed by Lily Ramsey, LLM

In a recent cross-sectional study published in JAMA Network Open, researchers from the United States of America (US) investigated, at the county level, the association between medical debt and population health outcomes in the US.

They found that medical debt is associated with worsened health status and increased premature deaths and mortality in the population.

Study: Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US . Image Credit: Pormezz/Shutterstock.com Background

Increasing economic burden and out-of-pocket costs for healthcare in the US have led to a concerning rise in medical debt, affecting 17.8% of individuals in 2020.

Certain vulnerable populations, including racial and ethnic minorities, females, younger individuals, and those with chronic diseases face a higher risk of incurring medical debt.

This debt is linked to adverse impacts on well-being, such as delayed healthcare, prescription nonadherence, and increased food and housing insecurity. Despite these individual-level associations, the county-level impact of medical debt on health outcomes remains poorly understood.

The present study aimed to address this gap by examining the relationships between medical debt and health status, mortality, and premature death at the county level in the US, using data from the Urban Institute Debt in America project. About the study

In the present study, debt data was obtained from a 2% nationally representative panel of deidentified records from a credit bureau. A total of 2,943 US counties were included, of which 39.2% were in metropolitan regions. The counties had a median 18.3% of residents above 65 years of age.

The median racial breakdown of residents was as follows: 0.4% American Indian/Alaska Native, 0.8% Asian/Pacific Islander, 3.0% Black, 4.3% Hispanic, and 84.5% White.

The excluded counties were predominantly non-metropolitan and had a smaller population size and a reduced socio-demographic diversity. Related StoriesDaily aspirin linked to higher mortality in older adults, study findsStudy suggests high levels of vitamin B3 breakdown products are linked to higher risk of mortality, heart attacks, and strokeCirculatory cholesterol levels are inversely linked to mortality of patients with sepsis and critical illness

The study investigated three health outcome sets from public data sources, including self-reported health status, premature death measured by years of potential life lost, and age-adjusted all-cause mortality rates and cause-specific mortality rates for leading causes such as cancers, heart disease, Alzheimer's, diabetes, and suicide, at the county level in the US.

Furthermore, the study considered county-level sociodemographic factors from the US Census data, including racial distribution, educational attainment, uninsured status, unemployment, and metropolitan status, as potential confounders.

The analysis considered two medical debt measures: the primary measure assessed the percentage of individuals with medical debt in collections, while the secondary measure focused on the median amount of medical debt (in 2018 US dollars).

Overall debt, including medical and other kinds of debt, were also included in the supplementary analyses.

Statistical analysis involved the use of descriptive analysis as well as bivariate and multivariable linear models, incorporating random state-level intercepts and weighted by county population size. Results and discussion

An average of 19.8% of the studied population had medical debt. Counties with fewer White and more Black residents, lower education levels, increased poverty, lack of insurance, and unemployment appeared to have higher medical debt rates.

It was found that a 1% increase in the population of medical debt-holders was associated with 18.3 more physically unhealthy days and 17.9 more mentally unhealthy days per 1,000 people in 30 days.

The percent-increase in medical debt-holders was also found to be associated with 1.12 years of life lost per 1,000 people and a rise of 7.51 per 100,000 person-years in age-adjusted all-cause mortality rate.

Consistent associations were found for major causes of death, including heart disease, cancer, chronic obstructive pulmonary disease, diabetes, and suicide.

Patterns were found to be similar for associations between the median amount of medical debt and the selected health outcomes. Supplemental analyses showed similar association patterns between medical debt and health outcomes.

This nationwide study reaffirms that medical debt remains a significant social determinant of public health.

However, the study is limited by the potential underrepresentation of medical debt in less populous counties, the inability to examine specific sources of medical debt, the exclusion of individuals not in the credit system, and the need for further research on the impact of coronavirus disease 2019 (COVID-19)-related policies on medical debt and population health.

Additionally, a broader focus on overall debt suggested that policies addressing various debts, like student loans, may impact population health. Conclusion

In conclusion, the study revealed associations between medical debt and adverse health outcomes, such as increased unhealthy days, premature deaths, and elevated mortality rates.

The results highlight the need for collaborative efforts among various stakeholders, including government entities, healthcare systems, hospitals, and employers, to mitigate medical debt with paid sick leave, clear financial assistance policies, and improved cost-related communication with patients.

Further, enhancing access to affordable healthcare through policies like expanding health insurance coverage may improve the overall health of the US population. Journal reference:

X. et al., (2024) Associations of Medical Debt with Health Status, Premature Death, and Mortality in the US. Han JAMA Network Open, 7(3):e2354766. doi: 10.1001/jamanetworkopen.2023.54766.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815530

Entertainment

Sabrina Carpenter hits out at ‘evil and disgusting’ White House video featuring her song

Published

30 mins ago

December 3, 2025

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Sabrina Carpenter hits out at 'evil and disgusting' White House video featuring her song

Sabrina Carpenter has hit out at an “evil and disgusting” White House video of migrants being detained that uses one of her songs.

“Do not ever involve me or my music to benefit your inhumane agenda,” the pop star posted on X.

The White House used part of Carpenter‘s upbeat song Juno over pictures of immigration agents handcuffing, chasing and detaining people.

It was posted on social media on Monday and has been viewed 1.2 million times so far.

President Trump‘s policy of sending officers into communities to forcibly round up illegal immigrants has proved controversial, with protests and legal challenges ongoing.

Mr Trump promised the biggest deportation in US history, but some of those detained have been living and working in the US for decades and have no criminal record.

Carpenter is not the only star to express disgust over the administration’s use of their music.

Olivia Rodrigo last month warned the White House not to “ever use my songs to promote your racist, hateful propaganda” after All-American Bitch was used in a video urging undocumented migrants to leave voluntarily.

In July, English singer Jess Glynne also said she felt “sick” when her song from the viral Jet2 advert was used over footage of people in handcuffs being loaded on a plane.

Other artists have also previously hit out at Trump officials for using their music at political campaign events, including Guns N’ Roses, Foo Fighters, Celine Dion, Ozzy Osbourne and The Rolling Stones.

Business

Thames Water debt pile rises further despite return to profit

Published

30 mins ago

December 3, 2025

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Thames Water debt pile rises further despite return to profit

Cash-strapped Thames Water has revealed a further rise in its debt pile while recording a return to profit on the back of inflation-busting hikes to bills.

The UK’s largest supplier said the 31% rise to customer bills since April had allowed it to increase capital investment by 22% to £1.3bn amid demands it improve performance in preventing sewage spills and stopping leaks.

Thames Water said it recorded a 20% drop in pollution incidents over the six months to the end of September, and leakage performance was holding steady despite the “extremely dry summer”.

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While waste complaints dipped by 11%, according to the company, there was a 42% surge in the number of customers complaining about the hike to bills.

Thames Water revenue rose 42% on the same period last year to £1.9bn, helping a return to profit after tax of £328m on the back of a £190m loss during April-September 2024.

The company said profitability was damaged by higher debt serving costs.

Its debt pile was recorded at £17.6bn – a rise of 5%.

The results were released against the backdrop of continuing talks involving the government and regulators over a proposed rescue deal by major Thames Water creditors.

Their consortium is known as London & Valley Water.

It effectively already owns Thames Water under the terms of a financial restructuring agreed early in the summer but regulator Ofwat is yet to give its verdict on whether the consortium can run the company, averting the prospect of it being placed in a special administration regime.

Without a deal the consortium, which includes investment heavyweights Elliott Management and BlackRock, would be wiped out.

Ofwat, which is to be scrapped under a shake-up of industry oversight, has been leading scrutiny of London & Valley’s operational plan and proposed capital structure.

The prospective deal would write off billions of pounds of the company’s debt and inject billions in fresh equity, in return for an adjustment in the regulator’s approach to future financial penalties.

Thames sees the creditors’ proposal as the only viable solution.

Despite huge hikes to household bills – allowed across England and Wales to bolster aging infrastructure including storm overflows – the company says its financial turnaround has been hampered by record fines for things like sewage leaks and bonuses to retain key staff.

Sky News revealed on Tuesday that its remuneration committee will meet next week to decide whether to proceed with nearly £2.5m in retention payments to 21 senior managers.

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Thames Water chief executive Chris Weston said the company had made good progress on its operational and transformation targets.

“This progress has all been achieved as we also manage the recapitalisation of the business. We continue to work closely with stakeholders to secure a market-led solution that we believe is in the best interests of our customers and the environment.

“This in turn will allow the transformation of Thames to continue, a programme that will take at least a decade to complete and will restore the infrastructure and operations of the company.”

Business

FIFA backs away from dynamic pricing for all World Cup 2026 tickets

Published

30 mins ago

December 3, 2025

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FIFA backs away from dynamic pricing for all World Cup 2026 tickets

FIFA has backed away from using dynamic pricing for all 2026 World Cup tickets amid concerns about the cost of attending the tournament in North America.

The organisers insisted they always planned to ring-fence tickets at set prices to follow your own team.

But the announcement comes just days ahead of Friday’s tournament draw in Washington DC, which Donald Trump plans to attend.

Fans will have to wait until Saturday to know exactly where and when their teams will be playing in next summer’s tournament.

Variable pricing – fluctuating based on demand – has never been used at a World Cup before, raising concerns about affordability.

England and Scotland fans have been sharing images in recent days of ticket website images highlighting cost worries.

But world football’s governing body said in a statement to Sky News: “FIFA can confirm ringfenced allocations are being set aside for specific fan categories, as has been the case at previous FIFA World Cups. These allocations will be set at a fixed price for the duration of the next ticket sales phase.

“The ringfenced allocations include tickets reserved for supporters of the Participating Member Associations (PMAs), who will be allocated 8% of the tickets for each match in which they take part, including all conditional knockout stage matches.”

FIFA says the cheapest tickets are from $60 (£45) in the group stage. But the most expensive tickets for the final are $6,730 (£5,094).

There will also be a sales window after the draw from 11 December to 13 January when ticket applications will be based on a fixed price for those buying in the random selection draw.

It is the biggest World Cup with 104 matches after the event was expanded from 32 to 48 teams. There are also three host nations for the first time – with Canada and Mexico the junior partners.

FIFA defended using fluctuating pricing.

“The pricing model adopted for FIFA World Cup 26 reflects the existing market practice for major entertainment and sporting events within our hosts on a daily basis, soccer included,” FIFA’s statement continued.

“This is also a reflection of the treatment of the secondary market for tickets, which has a distinct legal treatment than in many other parts of the world. We are focused on ensuring fair access to our game for existing but also prospective fans.”

The statement addressed the concerns being raised about fans being priced out of attending.

FIFA said: “Stadium category maps do not reflect the number of tickets available in a given category but rather present default seating locations.

“FIFA resale fees are aligned with North American industry trends across various sports and entertainment sectors.”

Ireland, Northern Ireland and Wales could also still qualify.