Medical debt linked to later-stage cancer diagnoses
Patients grappling with medical debt appear more likely to face later-stage cancer diagnoses, according to new research published Thursday.
Such financial obligations are a pervasive challenge among U.S. households and a key social determinant of health, experts write in JAMA Network Open. About 1 in 6 individuals here report having at least some medical debt, with millions facing collections—a situation disproportionately impacting low-income households, minorities and the uninsured.
Researchers aimed to better understand how these IOUs impact patient outcomes, analyzing data spanning nearly 3,000 U.S. counties. They found that higher burden of medical debt was associated with significantly increased incidence of late-stage lung, colorectal, cervical, skin, kidney, bladder, and head/neck cancer.
“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,” study co-author Xin Hu, PhD, with the Department of Radiation Oncology at Emory University, Atlanta, and colleagues wrote Oct. 1.
The cross-sectional study used county-level data linking 2016 medical debt with age-adjusted incidence rates of 9 cancers in the five years that followed. Prevalence of medical debt ranged from about 1% to 52%, with 21% in collections, the study found. Average medical debt prevalence was higher in rural counties than urban ones, along with socially vulnerable communities. Each 10 percentage-point increase in county-level medical debt was associated with a higher incidence of late-stage lung, colorectal, cervical, skin, kidney, bladder and head/neck cancer.
Similar patterns were seen for overall cancer incidence, the study found.
“The greater increase in late-stage incidence rates observed for lung cancer may partly reflect its close association with socioeconomic and behavioral risk factors, including tobacco use and environmental or occupational exposures,” the authors wrote. “Lung cancer screening also requires repeated annual imaging and follow-up of abnormal findings, which may impose logistical and financial barriers and contribute to disparities in screening uptake and adherence.”
In a corresponding editorial, experts noted that the Affordable Care Act requires health plans to fully cover preventive healthcare, including routine cancer screenings. However, these protections don’t apply to any recommended follow-ups and diagnostic studies after a positive screening, which can be a significant expense. Advocacy groups have pushed for policies defining recommended follow-up testing as part of the “screening continuum.” But further protections are needed across diverse cancer types.
“The study’s findings have a foundational role to play in informing future research, policy and clinical practice to promote equitable cancer care,” Fumiko Chino, MD, with the Department of Radiation Oncology at the MD Anderson Cancer Center, Houston, et al. wrote Thursday. “Protecting patients from the compounding effects of medical debt and late-stage cancer diagnoses will require further investigations confirming the study’s results by incorporating individual-level risk factors and healthcare utilization data; actionable and enforceable policies that protect patients against medical debt; and improved recognition of—and intervention for—medical debt among clinicians.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.