TOPLINE

A cross-sectional study of 2958 US counties found that higher levels of medical debt in collections were associated with a higher incidence of late-stage cancer. For every 10-percentage-point rise in county-level medical debt, late-stage lung cancer incidence rose by 5.15 cases per 100,000 person-years, with smaller but significant increases seen for colorectal, cervical, kidney, bladder, and head and neck cancers as well as melanoma.

METHODOLOGY

• Medical debt affects roughly 1 in 6 individuals in the US and burdens low-income, uninsured, and socially deprived populations. Financial barriers can dissuade people from seeking preventive care, delaying timely diagnosis. The stage at cancer diagnosis is strongly predictive of survival; however, whether community-level medical debt is associated with an advanced-stage cancer diagnosis is unclear.
• To find out, researchers conducted a cross-sectional ecological study linking 2016 county-level medical debt data with age-adjusted cancer incidence rates recorded from January 2017 through December 2021 across 2958 US counties. Data on medical debt in collections came from the Urban Institute Debt in America project's 2% nationally representative sample of consumer credit records.
• Age-adjusted all-stage and late-stage incidence rates were estimated per 100,000 person-years for nine cancers with recognizable symptoms and amenable to screening, including lung, colorectal, cervical, breast, prostate, kidney and renal pelvis, bladder, and head and neck cancers as well as melanoma. Using these measures, researchers assessed associations between community-level medical debt and all-stage and late-stage cancer incidence.
• Overall, the study included 1154 urban (39.0%) and 1804 rural (61.0%) counties, with a mean prevalence of medical debt in collections of 21.1% and a mean primary care physician density of 0.54 physicians per 1000 people.

TAKEAWAY

• Higher medical debt burden correlated with higher incidence rates of late-stage and all-stage cancer across most cancer types. Each 10-percentage-point increase in county-level medical debt was linked to 5.15 additional cases of late-stage lung and bronchus cancer per 100,000 person-years (P < .001), representing the most pronounced association observed among the nine cancers.
• Additionally, medical debt was positively associated with the incidence of late-stage colorectal, cervical, kidney and renal pelvis, bladder, and head and neck cancers as well as melanoma, with each 10-percentage-point increase linked to additional cases ranging from 0.24 to 0.92 per 100,000 person-years (P < .001 for all). Comparable positive associations were seen for incidence rates of all-stage cancer.
• However, medical debt was inversely associated with the incidence of prostate cancer; each 10-percentage-point increase in debt was linked to 0.80 fewer late-stage cases per 100,000 person-years (P < .001), with a similar but nonsignificant trend for all-stage cases (P = .09). 
• In sensitivity analysis, counties in the highest medical debt quartile had higher late-stage cancer rates than those in the lowest quartile, including a 39% higher rate of lung cancer (rate ratio [RR], 1.39; P < .001) and a 24% higher rate of cervical cancer (RR, 1.24; P < .001).

IN PRACTICE

″These findings suggest that medical debt may be an area-level marker of structural and financial barriers associated with cancer detection and cancer outcomes at the population level,″ the authors wrote. ″Reducing medical debt and strengthening financial protections may help mitigate barriers to cancer prevention and care.″ 

SOURCE

The study, led by Jiazhang Xing, MD, of Sinai Hospital of Baltimore in Baltimore, was published online in JAMA Network Open.

LIMITATIONS

Ecological, county-level design limited causal inference and could not confirm that residents with cancer were the same individuals carrying medical debt. Unmeasured confounders, within-county heterogeneity, and missing data on debt amount relative to income further limited interpretation.

DISCLOSURES

The authors did not disclose any funding information. Several authors reported receiving grants or fees from pharmaceutical firms and foundations unrelated to this work. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.