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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 

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Technology

Tata, Intel deepen India semiconductor push with pact on chip supply chain and AI PCs

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Tata, Intel deepen India semiconductor push with pact on chip supply chain and AI PCs

Signage for Tata Electronics Pvt Ltd. at the company’s factory in Hosur, Tamil Nadu, India, on Tuesday, Aug. 5, 2025.

Bloomberg | Bloomberg | Getty Images

Tata Electronics has lined up American chip designer Intel as a prospective customer as the division of Mumbai-based conglomerate Tata Group works to expand India’s domestic electronics and semiconductor supply chain. 

Under a Memorandum of Understanding, the companies will explore the manufacturing and packaging of Intel products for local markets at Tata Electronics’ upcoming plants.

Intel and Tata also plan to assess ways to rapidly scale tailored artificial intelligence PC solutions for consumers and businesses in India. 

In a press release on Monday, Tata said that the collaboration marks a pivotal step towards developing a resilient, India-based electronics and semiconductor supply chain.

“Together [with Intel], we will drive an expanded technology ecosystem and deliver leading semiconductors and systems solutions, positioning us well to capture the large and growing AI opportunity,” said N Chandrasekaran, Chairman of Tata Sons, the principal investment holding company of Tata companies. 

Tata Electronics, established in 2020, has been investing billions to build India’s first pure-play foundry. The facility will manufacture semiconductor products for the AI, automotive, computing and data storage industries, according to Tata Electronics

The firm is also building new facilities for assembly and testing. 

India, despite being one of the world’s largest consumers of electronics, lacks chip design or fabrication capabilities. 

However, the Indian government has been working to change that as part of efforts to reduce dependence on chip imports and capture a bigger share of the global electronics market, which is shifting away from China.

Under New Delhi’s “India Semiconductor Mission,” at least 10 semiconductor projects have been approved with a cumulative investment of over $18 billion.

Intel CEO Lip-Bu Tan said the partnership with Intel was a “tremendous opportunity” to rapidly grow in one of the world’s fastest-growing computer markets, fueled by rising PC demand and rapid AI adoption across India.

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World

Ukraine war: The signs Putin is expecting more conflict, not less – and the frank conversation Keir Starmer needs to have

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Ukraine war: The signs Putin is expecting more conflict, not less - and the frank conversation Keir Starmer needs to have

With more than a thousand troops being killed or wounded every day, there’s no sign that Donald Trump’s push to end Russia’s war in Ukraine is reducing the battles on the ground.

Quite the opposite.

Ukraine‘s military chief says Vladimir Putin is instead using the US president‘s focus on peace negotiations as “cover” while Russian soldiers attempt to seize more land.

That means much greater pressure on the Ukrainian frontline, even as Russian and American, or American and Ukrainian, or Ukrainian and European, leaders shake hands and smile for cameras before retreating behind closed doors in Moscow, Alaska, and London.

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This was not an upbeat meeting of Ukraine and its allies

Putin’s not counting on peace

The lack of any indicators that the Kremlin is looking to slow its military machine down also makes the risk of war spreading beyond Ukraine’s borders increasingly likely.

It takes a huge amount of effort, time, and money to put a country on a war footing as Putin has done, partially mobilising his population, allocating huge portions of government spending to the military and realigning Russia’s vast industrial base to produce weapons and ammunition.

Putin has been in India to shore up support from Narendra Modi. Pic: Reuters
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Putin has been in India to shore up support from Narendra Modi. Pic: Reuters

But when the fighting stops, it requires almost as much focus and energy to switch a society back to a peace time rhythm.

Deliberately choosing not to dial defence down once the battles cease means a nation will continue to grow its armed forces and weapons stockpiles – a sure sign that it has no intention of being peaceful and is merely having a pause before going on the attack again.

The absence of any preparations by Moscow to slow the tempo of its military operations in Ukraine – where it has more than 710,000 troops deployed along a 780-mile frontline – is perhaps an indicator that Putin is anticipating more not less war.

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What is Putin trying to achieve in India?

How could the war end?

What happens next in Europe will depend on the content of any peace deal on Ukraine.

An all-out Russian defeat is all but impossible to conceive without a significant change of heart by the Trump White House and a massive increase in weapons and support.

The next best result for Ukraine would be a settlement that seeks to strike a fair balance between the warring sides and their conflicting objectives.

This could be done by pausing the fighting along the current line of contact before substantive peace talks then take place, with Ukraine’s sovereignty supported by solid security guarantees from Europe and the US.

But such a move would require Europe’s NATO allies, led by the UK, France and Germany, genuinely to switch their respective militaries and populations back to a wartime footing, with a credible readiness to go to war should Moscow attempt to test their support of Ukraine.

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Why Ukraine’s allies may welcome Trump walking away

Will Starmer level with the public?

That does not just mean increased spending on defence at a much faster rate – in the UK at least – than is currently planned. It is also about the mindset of a country and its willingness to take some pain.

France is already openly saying that parents may have to lose their children in a war with Russia, while Germany is requiring all 18-year-old men to undergo medical checks for possible national service.

No such tough but frank conversation is being attempted by Sir Keir Starmer with the British public.

The furthest his military chief has gone is to say “warfighting readiness” is his top priority.

But that is meaningless jargon for most of the public. Being ready for war is about so much more than what the professional armed forces can do.

Armies fight battles. Countries fight wars.

Read more:
UK unveils undersea tech
Navy chief offers chilling warning
Does Britain’s threat to Russia ring hollow?

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New UK military technology unveiled

Worst case scenario?

The other alternative when it comes to Ukraine is a scenario that sees a sidelined Europe unable to influence the outcome of the negotiations and Kyiv forced to agree to terms that favour Moscow.

This would include the surrender of land in the Donbas that is still under Ukrainian control.

Such a deal – even if tolerated by Ukraine, which is unimaginable without serious unrest – would likely only mean a temporary halt in hostilities until Putin or whoever succeeds him decides to try again to take the rest of Ukraine, or maybe even test NATO’s borders by moving against the Baltic States.

With Trump’s new national security strategy making clear the US would only intervene to defend Europe if such a move is in America’s interests, it is no longer certain that the guarantees contained in NATO’s founding Article 5 principle – that an attack on one member state is an attack on all – can be relied upon.

To have a sense of how a war with Russia might play out without the US on NATO’s side, Sky News and Tortoise ran a wargame that simulates a Russian attack on the UK.

In the scenario, Washington does not come to Britain’s defences, which leaves the British side with very few options to respond short of a nuclear strike.

👉Search for The Wargame on your podcast app👈

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World

Powerful earthquake in northern Japan triggers tsunami, injuring 33

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 Powerful earthquake in northern Japan triggers tsunami, injuring 33

A powerful earthquake struck off northern Japan, injuring 33 people and unleashing a tsunami.

The 7.5-magnitude quake struck at about 11.15pm local time, around 80 kilometers off the coast of Aomori prefecture.

Japan’s Fire and Disaster Management Agency said 33 people were injured, including one seriously, with most hurt by falling objects.

A road is congested with cars heading for higher ground in Tomakomai City December 8, 2025 after a magnitude 7.6 earthquake. Pics: AP
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A road is congested with cars heading for higher ground in Tomakomai City December 8, 2025 after a magnitude 7.6 earthquake. Pics: AP

A tsunami of 70cm was measured just south of Aomori, in Kuji port, Iwate prefecture, while levels of up to 50cm struck elsewhere in the region, the Japan Meteorological Agency said.

“I’ve never experienced such a big shaking,” said Nobuo Yamada, who owns a convenience store in Hachinohe, Aomori, in an interview with public broadcaster NHK.

Earlier on, the meteorological agency issued an alert for potential tsunami surges of up to 3m/10ft, with 90,000 residents ordered to evacuate.

Residents were urged by chief cabinet secretary Minoru Kihara to go to higher ground or seek shelter until advisories were lifted.

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People sheltering today in Kamaishi Elementary School in Kamaishi City, Miyagi Prefecture. Pic: AP
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People sheltering today in Kamaishi Elementary School in Kamaishi City, Miyagi Prefecture. Pic: AP

He said about 800 homes were without electricity, and that the Shinkansen bullet trains and some local lines were suspended in parts of the region.

Some 480 residents took shelter at the Hachinohe Air Base, defence minister Shinjiro Koizumi said, with 18 defence helicopters mobilised for damage assessments.

While Satoshi Kato, vice principal of a public high school in the same town, encountered traffic jams and car accidents en-route to the school as panicked people tried to flee.

Japan has recent experience of the perils of earthquakes – one in 2011 unleashed a tsunami that killed some 20,000 people and triggered a nuclear meltdown at the Fukushima Daiichi Nuclear Power Plant.

The earthquake warning off the coast of Aomori Prefecture, Japan. Pic: AP
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The earthquake warning off the coast of Aomori Prefecture, Japan. Pic: AP

Today’s quake caused about 450 litres of water to spill from a spent fuel cooling area at the Rokkasho fuel reprocessing plant in Aomori, the Nuclear Regulation Authority said.

But water levels remained within the normal range and there was no safety concern, the authority added.

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Japan sends in troops over deadly bear attacks

The Japanese government has now lifted all remaining tsunami advisories, but warned people to remain alert for another week in case of aftershocks.

Satoshi Harada, from the meteorological agency’s earthquake and volcano division, cautioned that the 2011 quake could repeat itself.

“You need to prepare, assuming that a disaster like that could happen again,” he said.

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