U.S. counties with higher shares of residents carrying medical debt in collections had higher rates of late-stage cancer diagnoses, according to an Oct. 1 study in JAMA Network Open.
Researchers from Baltimore-based Sinai Hospital, the Atlanta-based American Cancer Society and other institutions analyzed 2016 medical debt data and 2017-2021 cancer incidence rates across 2,958 counties to assess whether medical debt was linked to late-stage diagnoses across nine cancer types.
- Each 10-percentage-point increase in a county’s share of residents with medical debt was associated with 5.15 additional late-stage lung cancer cases per 100,000 people per year.
The same percentage-point increase was associated with less than one additional case per 100,000 people per year for late-stage colorectal, cervical, melanoma, kidney, bladder and head and neck cancers. - Late-stage lung cancer rates were 39% higher in the quarter of counties with the most medical debt than in the quarter with the least. High-debt counties also had 24% higher late-stage cervical cancer rates and 14% higher late-stage colorectal cancer rates.
- Higher medical debt was tied to lower late-stage prostate cancer incidence, which researchers said could be attributed to fewer screening and testing in those counties.
Medical debt was not significantly linked to late-stage breast cancer rates, which researchers said may reflect free and low-cost screening programs for low-income women. - On average, 21% of a county’s residents had medical debt in collections. That share ranged from 1.2% in the lowest-debt county to 51.8% in the highest.
The share of residents with medical debt averaged 27.4% in the most socially vulnerable quarter of counties, 13.9% in the least vulnerable quarter, 21.5% in rural counties and 20.5% in urban counties. - Counties with both high medical debt and high cancer rates were clustered in the South and Southwest.
Read the full study here.
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