Research analyzing data from 2,958 U.S. counties reveals a correlation between higher medical debt and increased late-stage cancer diagnoses. The study found that for every 10-percentage point rise in county-level medical debt, there were 5.15 more late-stage lung cancer cases per 100,000 person-years, highlighting a significant association between financial strain and advanced cancer detection.
Higher medical debt was also tied to additional late-stage cases of several other cancers, including colorectal, cervical, melanoma, kidney and renal pelvis, bladder, and head and neck cancers. The study’s findings were published in JAMA Network Open.
The researchers found that the mean prevalence of medical debt in collections was 21.1%, and the mean primary care physician density was 0.54 physicians per 1,000 population. The mean medical debt prevalence was higher in rural versus urban counties, and in counties with higher Social Vulnerability Index quartiles. Notably, among the 2,958 U.S. counties included in the analysis, 61% were rural, which may have implications for access to healthcare and cancer screening.
Compared with counties in the lowest quartile of medical debt burden, those in the highest quartile had a higher incidence of late-stage cancer for most cancer types. They suggested that reducing medical debt and strengthening financial protections may help mitigate barriers to cancer prevention and care.
Potential strategies for reducing medical debt and improving cancer outcomes include expanding insurance coverage, reducing out-of-pocket costs, limiting aggressive billing practices, and implementing financial navigation programs. The study’s findings have implications for policy, practice, and future research.
Nicole M. Mott, MD, MSCR, and Fumiko Chino, MD, noted in an accompanying editorial that other studies have shown that a large burden of medical debt is associated with reduced cancer screening rates and more deaths from screening-eligible cancers. They suggested that medical debt may be a marker for structural disadvantage and a potentially modifiable risk factor for delayed care and worse outcomes.
The study’s authors acknowledged that its design precluded individual-level causal inference, and that county-level findings may not reflect associations at the patient level. They also noted that the lower incidence of prostate cancer in counties with greater medical debt may reflect lower diagnostic intensity, rather than lower underlying disease burden.
The study’s results indicate that medical debt is a significant factor in late-stage cancer diagnoses, and these findings were in line with those of another recent study showing that the greatest proportion of cancer patients with a diagnosis of stage IV disease and lower 5-year survival rates was observed in counties with the highest medical debt.
