Medical debt is associated with population health and increased mortality

Published

2 months 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

Melissa McCarthy responds to Barbra Streisand’s apology after Ozempic comment

Published

2 hours ago

May 1, 2024

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Melissa McCarthy responds to Barbra Streisand's apology after Ozempic comment

Hollywood star Melissa McCarthy has responded by saying, “I win the day”, after Barbra Streisand was criticised for asking her if she had taken a weight-loss drug.

Bridesmaids star McCarthy had posted an image of herself on Instagram at a charity gala alongside US director Adam Shankman on Monday.

Streisand, the legendary singer and actress, replied in a comment below: “Give him my regards, did you take Ozempic?”

The drug can only be prescribed for patients with Type 2 diabetes and is not licensed as a weight-loss treatment in the UK or US.

Streisand posted an apology on X for her original comment which was swiftly deleted after it sparked a backlash online.

In a short video shared on Instagram, hours after the apology, McCarthy said: “The takeaway: Barbra Streisand knows I exist, she reached out to me and she thought I looked good. I win the day.”

McCarthy was holding up a magazine with Streisand on the cover in the video, which was filmed at the premiere of the new Netflix movie Unfrosted, in Los Angeles on Tuesday.

The 53-year-old will appear in the film alongside Jerry Seinfield and Hugh Grant when it is released this month.

McCarthy was earlier asked by a photographer in Los Angeles what she thought of Streisand’s comments and replied: “I think Barbra is a treasure, and I love her.”

‘I forgot the world is reading’

Streisand, 82, had said in her apology earlier on Tuesday: “I went on Instagram to see the photos we’d posted of the beautiful flowers I’d received for my birthday.

“Below them was a photo of my friend Melissa McCarthy, who I sang with on my Encore album.

“She looked fantastic! I just wanted to pay her a compliment, I forgot the world is reading!”

In response to Streisand’s original comment referring to Ozempic, one social media user wrote: “Omg somebody please teach Barbra Streisand how to send a DM.”

Another wrote: “Omg…this comment from Barbra Streisand. Yes, it’s real, but she’s deleted it.”

Ozempic works by suppressing the appetite and lengthens the amount of time food stays in the stomach, leading to weight loss – at least for as long as you carry on taking it.

It has been banned as a treatment for obesity in the UK due to high demand for the drug causing a global shortage.

Numerous Hollywood stars are rumoured to have used Ozempic to lose weight – but just a handful of celebrities have admitted it publicly.

Stephen Fry was prescribed the drug in the US “years ago” and said earlier this year that side effects included vomiting up to five times a day.

Oprah Winfrey has said she has also taken weight-loss drugs, though she’s declined to specify which ones.

Entertainment

FKA Twigs reveals she has created an AI clone – but condemns unauthorised deepfakes

Published

2 hours ago

May 1, 2024

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FKA Twigs reveals she has created an AI clone - but condemns unauthorised deepfakes

FKA Twigs has revealed she has created an AI version of herself to engage with fans and help with promotion.

The British singer-songwriter and dancer gave details of the project as she addressed a US Senate intellectual property hearing regarding the No Fakes Act, which aims to crack down on unauthorised replicas.

FKA Twigs, whose real name is Tahliah Debrett Barnett, confirmed she had been developing her own AI – but condemned unauthorised deepfakes, saying they leave her feeling “raw and vulnerable”.

The hearing was held in Washington on Tuesday, just hours before the release of a UK report which found that most of the public want regulation to prevent deepfakes of big-name artists such as Dua Lipa and Taylor Swift.

Speaking at the US hearing, FKA Twigs said she had been developing a digital clone of herself over the past year, revealing that it can speak multiple languages.

“I’ve done this to be able to reach more of my fans and to be able to speak to them in the nuance of their language,” she said. “I’ve currently explored French, Korean and Japanese, which is really exciting for me. It means that even with my upcoming album I can really explain in depth what it’s about creatively.”

The 36-year-old said having an AI version of herself also allows her to “spend more time making art”.

She continued: “Often being a music artist, or any artist in this day and age, requires a lot of press and a lot of promo, a lot of one-liners.

“So it means if it’s something simple that doesn’t really require my heart, I can do a one-liner and give it to people to promote a piece of work and, you know, it’s harmless but ultimately I can spend more time making something that’s really meaningful for my fans.”

‘I am a human being, and we have to protect that’

Addressing unauthorised deepfakes, she told the hearing about songs and collaborations with other artists that exist online, which she had nothing to do with.

“The fact that somebody could take my voice, change lyrics, change messaging, maybe work with an artist that I didn’t want to work with, or maybe work with an artist that I wanted to work with and now the surprise is ruined, it really leaves me very raw and very vulnerable,” she said.

The star called for legislation to protect artists and added: “My spirit, my artist and my brand is my brand, and I’ve spent years developing it.

“And it’s mine, it doesn’t belong to anybody else to be used in a commercial sense, or cultural sense, or even just for a laugh. I am me, I am a human being, and we have to protect that.”

Unacknowledged AI music: Is it theft?

Meanwhile, a poll by the All-Party Parliamentary Group (APPG) on Music has found that 83% of UK adults agree that a music artist’s creative “personality” should be protected in law against AI copies.

The research involving more than 2,000 adults also found that 83% agree with the statement that if AI has been used to generate a song it must be clearly labelled, and 77% believe it amounts to theft when generated music fails to acknowledge the creator of the original.

APPG recommendations include the government introducing a UK AI Act, generated music being clearly labelled, the creation of a personality right to protect creators and artists from deepfakes, misappropriation and false endorsement, and setting up an international taskforce.

A government spokesperson said: “We are committed to helping artists and the creative industries work with the AI sector to harness the opportunities this technology provides, and ensure our music can continue to be enjoyed around the world.”

In April, more than 200 artists signed an open letter objecting to the “predatory” use of AI to “steal professional artists’ voices and likenesses”.

World

Ex-politician seen beating his wife to death in CCTV footage – sparking outrage in Kazakhstan

Published

2 hours ago

May 1, 2024

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Ex-politician seen beating his wife to death in CCTV footage - sparking outrage in Kazakhstan

The murder trial of a former senior politician in Kazakhstan who has been accused of beating his wife to death has attracted the attention of the nation, sparking calls for new legislation tackling domestic violence.

Shocking footage showing businessman Kuandyk Bishimbayev, Kazakhstan’s former economy minister, beating his wife at a family restaurant has been streamed online from the court.

The case has touched a nerve among the public as tens of thousands of people have signed petitions calling for new laws to hold those guilty of abuse to account.

Why is the case so high profile?

The trial of Bishimbayev, 44, is the first in the country to ever be streamed online – making it readily accessible to the 19 million people in Kazakhstan.

The former politician was already well known, having been jailed for bribery in 2018. He spent less than two years of his 10-year sentence in prison before he was pardoned.

Bishimbayev was charged with torturing and killing his wife after her death last November. For weeks, he maintained his innocence but admitted last month in court that he had beaten her and “unintentionally” caused her death.

Saltanat Nukenova, 31, was found dead in November in a restaurant owned by one of her husband’s relatives.

Disturbing CCTV footage shows the defendant, a father of four, dragging his wife by her hair, and then punching and kicking her.

Hours after it was recorded, she died of brain trauma.

Bishimbayev’s lawyers initially disputed medical evidence indicating Ms Nukenova died from repeated blows to the head.

They also portrayed her as prone to jealousy and violence, although no video from the restaurant’s security cameras that was played in court has shown her attacking Bishimbayev.

According to a 2018 study backed by UN Women, about 400 women die as a result of domestic violence in Kazakhstan every year, although many go unreported.

What reaction has the trial caused?

Tens of thousands of people in the country have signed a petition calling for harsher measures against perpetrators of domestic violence in the wake of Ms Nukenova’s tragic death.

The signatures resulted in senators approving a bill which toughens spousal abuse laws last month – dubbed “Saltanat’s Law”.

Aitbek Amangeldy, Ms Nukenova’s brother and a key prosecution witness, told the Associated Press he had no doubt his sister’s tragic fate has shifted attitudes about domestic violence.

“It changes people’s minds when they see directly what it looks like when a person is tortured.”