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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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Lightning sign McDonagh to 3-year, $12.3M deal

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Lightning sign McDonagh to 3-year, .3M deal

TAMPA, Fla. — The Tampa Bay Lightning have signed veteran defenseman Ryan McDonagh to a three-year extension worth $12.3 million.

General manager Julien BriseBois announced the deal Thursday. McDonagh will be 37 when the new contract kicks in; it counts $4.1 million against the salary cap through the 2028-29 season.

McDonagh helped the Lightning win back-to-back Stanley Cups in 2020 and 2021 and reach the Final in 2022 before losing in six games to the Colorado Avalanche.

They traded him to the Nashville Predators that summer to clear cap space at a time when it was not going up much because of the pandemic and reacquired him in 2024.

Record cap increases will have McDonagh account for less than 4% of the cap each of the next three years.

McDonagh is currently injured, one of several players Tampa Bay has been missing, along with No. 1 defenseman Victor Hedman. The team has still won 16 of 26 games and leads the Atlantic Division.

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UK

Officials accused of ‘failing’ to tell Lords about three large-scale illegal waste sites

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Officials accused of 'failing' to tell Lords about three large-scale illegal waste sites

Environment Agency bosses have been accused of “failing” to tell a cross-party committee of peers about three large-scale illegal waste sites – including one that was recently exposed by Sky News. 

Our investigation into waste crime in Wigan heard from residents who repeatedly complained to the Environment Agency that 20 to 30 lorries a day drove down their street last winter and dumped industrial amounts of waste.

The rubbish now sits at a staggering 25,000 tonnes. It burnt for nine days in July, and has seen local homes infested with rats and flies.

Since then, a similarly sized site in Kidlington near the River Cherwell in Oxfordshire sparked national outrage. One man has been arrested in connection with the dumping.

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‘Epidemic’ of waste crime in Britain

Despite the scale of these two locations – which were well known to the Environment Agency – it neglected to name them when asked by the Lord’s Environment Committee’s inquiry into waste crime how many “significant” sites there were around the country.

Phil Davies and Steve Molyneux of the Environment Agency gave evidence on 17 September.

Just six sites were cited, but three more have been exposed in the past few weeks alone. These are Wigan, Kidlington and a mound of dumped waste in Wadborough.

Now, the Lords are worried there are more environmentally destructive locations the public aren’t aware of.

Read more:
A community plagued by 25,000 tonnes of illegal waste

Urgent action needed to stop fly-tipping by gangs, peers say

In a letter to the EA’s chair Alan Lovell and chief executive Philip Duffy, Baroness Sheehan, chair of the Environment and Climate Change Committee, said: “We are increasingly concerned that there may be other sites of a similarly large and environmentally damaging scale.”

She asked how much progress has been made to remove waste from the various sites, why restriction notices in places like Wigan weren’t served sooner – and for a full list of other sites of a similar size.

Baroness Sheehan also expressed her “disappointment” that these three new locations “were not deemed necessary to bring to the committee’s attention”, though she thanked journalists for “bringing these sites to the public attention”.

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UK’s ‘biggest ecological disaster’

Her original report saw the Lords call for an independent “root and branch” inquiry into how waste crime is tackled. She said the crime, which costs the UK £1bn every year, has been “critically under-prioritised”.

Sky News has been investigating the scourge of waste crime all year, exposing how criminal gangs involved in drugs, weapons and people trafficking can make “millions” from illegally dumping waste.

In the summer, we tracked down a group of suspected organised fly-tippers who waved wads of cash on TikTok after dumping waste in the countryside.

It’s so lucrative, it was dubbed the “new narcotics” by a former head of the Environment Agency.

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UK

Starmer wants to lift half a million children out of poverty – but does his plan go far enough?

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Starmer wants to lift half a million children out of poverty - but does his plan go far enough?

A new long-awaited child poverty strategy is promising to lift half a million children out of poverty by the end of this parliament – but critics have branded it unambitious. 

The headline announcement in the government’s plan is the pledge to lift the two-child benefit cap, announced in Rachel Reeves’s budget last week.

It also includes:

• Providing upfront childcare support for parents on universal credit returning to work
• An £8m fund to end the placement of families in bed and breakfasts beyond a six-week limit
• Reforms to cut the cost of baby formula
• A new legal duty on councils to notify schools, health visitors, and GPs when a child is placed in temporary accommodation

Many of the measures have previously been announced.

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Two-child cap ‘a real victory for the left’

The government also pointed to its plan in the budget to cut energy bills by £150 a year, and its previously promised £950m boost to a local authority housing fund, which it says will deliver 5,000 high-quality homes for better temporary accommodation.

Downing Street said the strategy would lift 550,000 children out of poverty by 2030, saying that would be the biggest reduction in a single parliament since records began.

More on Poverty

But charities had been hoping for a 10-year strategy and argue the plan lacks ambition.

A record 4.5 million children (about 31%) are living in poverty in the UK – 900,000 more since 2010/11, according to government figures.

Phillip Anderson, the Strategic Director for External Affairs at the National Children’s Bureau (NCB), told Sky News: “Abolishing the two-child limit is a hell of a centre piece, but beyond that it’s mainly a summary of previously announced policies and commitments.

“The really big thing for me is it misses the opportunity to talk about the longer term. It was supposed to be a 10-year strategy, we wanted to see real ambition and ideally legally binding targets for reducing poverty.

“The government itself says there will still be around four million children living in poverty after these measures and the strategy has very little to say to them.”

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‘A budget for benefits street’

‘Budget for benefits street’ row

The biggest measure in the strategy is the plan to lift the two-child benefit cap from April. This is estimated to lift 450,000 children out of poverty by 2030, at a cost of £3bn.

The government has long been under pressure from backbench Labour MPs to scrap the cap, with most experts arguing that it is the quickest, most cost-effective way to drive-down poverty this parliament.

The cap, introduced by Conservative chancellor George Osborne in 2017, means parents can only claim universal credit or tax credits for their first two children. It meant the average affected household losing £4,300 per year, the Institute for Fiscal Studies calculated in 2024.

The government argues that a failure to tackle child poverty holds back the economy, and young people at school, cutting their employment and earning prospects in later life.

However, the Conservatives argue parents on benefits should have to make the same financial choices about children as everyone else.

Shadow chancellor Mel Stride said: “Work is the best way out poverty but since this government took office, unemployment has risen every single month and this budget for Benefits Street will only make the situation worse. “

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OBR leak: This has happened before

‘Bring back Sure Start’

Lord Bird, a crossbench peer who founded the Big Issue and grew up in poverty, said while he supported the lifting of the cap there needed to be “more joined up thinking” across government for a longer-term strategy.

He has been pushing for the creation of a government ministry of “poverty prevention and cure”, and for legally binding targets on child poverty.

“You have to be able to measure yourself, you can’t have the government marking its own homework,” he told Sky News.

Lord Bird also said he was a “great believer” in resurrecting Sure Start centres and expanding them beyond early years.

The New Labour programme offered support services for pre-school children and their parents and is widely seen to have improved health and educational outcomes. By its peak in 2009-2010 there were 3,600 centres – the majority of which closed following cuts by the subsequent Conservative government.

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Lord Bird on the ‘great distraction’ from child poverty

PM to meet families

Sir Keir Starmer’s government have since announced 1,000 Best Start Family Hubs – but many Labour MPs feel this announcement went under the radar and ministers missed a trick in not calling them “Sure Starts” as it is a name people are familiar with.

The prime minister is expected to meet families and children in Wales on Friday, alongside the Welsh First Minister, to make the case for his strategy and meet those he hopes will benefit from it.

Several other charities have urged ministers to go further. Both Crisis and Shelter called for the government to unfreeze housing benefit and build more social rent homes, while the Children’s Commissioner for England, Dame Rachel de Souza, said that “if we are to end child poverty – not just reduce it” measures like free bus travel for school-age children would be needed.

The strategy comes after the government set up a child poverty taskforce in July 2024, which was initially due to report back in May. The taskforce’s findings have not yet been published – only the government’s response.

Sir Keir said: “Too many children are growing up in poverty, held back from getting on in life, and too many families are struggling without the basics: a secure home, warm meals and the support they need to make ends meet.

“I will not stand by and watch that happen, because the cost of doing nothing is too high for children, for families and for Britain.”

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