Medical debt in the US linked to late-stage cancer — News-Medical

In the United States, counties with a higher share of people carrying unpaid medical debt recorded higher incidence rates of several common cancers at late stages. This is stated in a study published in JAMA Network Open, News-Medical reports.

Data from nearly three thousand counties

Researchers analyzed data from 2,958 US counties. They compared the share of people with medical debts sent to collections in 2016 with cancer incidence rates in 2017–2021. Late stage was defined as regional or distant spread of the disease.

On average, 21.1% of people with a credit bureau record in the counties included in the analysis had medical debts sent to collections. Higher levels of such debt were recorded in rural areas, as well as in counties with greater social vulnerability and larger shares of unemployed and uninsured residents. The researchers accounted for social vulnerability, a county’s urban or rural status, primary care physician density, differences between states, and population size.

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The strongest association was for lung cancer

Every 10-percentage-point increase in the prevalence of medical debt was associated with an increase of 5.15 cases of late-stage lung cancer per 100,000 person-years. Increases were also found for colorectal cancer, by 0.69 cases; melanoma, by 0.59; cervical cancer, by 0.39; kidney and renal pelvis cancer, by 0.38; bladder cancer, by 0.24; and head and neck cancer, by 0.92 cases per 100,000 person-years.

No statistically significant association was recorded for breast cancer in the main analysis. At the same time, a higher prevalence of medical debt was associated with a lower incidence of late-stage prostate cancer. The authors noted that this may reflect lower intensity of screening and diagnosis rather than a lower actual prevalence of the disease.

The study is ecological, meaning population-based, and therefore does not prove that medical debt itself caused later cancer detection. It also does not establish whether people with debt were the same patients diagnosed with cancer. Other socioeconomic, behavioral, and healthcare-system-related factors may also have influenced the results.