Falling Short: Examining Medical Debt and Cost Avoidance in American Indian and Alaska Native Households

Hubbard, Sean A.; Chen, Patricia M.

doi:10.1353/hpu.2022.0136

Cited by 2 publications

(3 citation statements)

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“…While parasitic transmission can be blunted through improved sanitation efforts, clean drinking water, and access to medical care, many underserved populations struggle to meet these necessities, [1][2][3] and as a result, have been established to have a higher seroprevalence of parasitic infections. 4 Children in these populations are of particular concern because of the increased hand-to-mouth transmission from soil.…”

Section: Textmentioning

confidence: 99%

Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area

McKim,

Kopystynsky,

Wolf

et al. 2023

Preprint

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The amounts of parasite DNA in soil samples from different playgrounds and other public areas can help identify areas of possible microbe transmission as well as giving indications of possible occurrence of parasite infection in nearby communities. We collected 207 soil samples from parks located on Paiute indigenous tribal areas in southwest Utah and from higher income city of St. George, Utah, and tested them for the presence of 11 parasites that can cause human disease. Molecular tests revealed elevated odds ratio of detecting the helminth Trichuris trichiura 3.072 (1.114 to 8.065) and any protozoa (not including Acanthamoeba) 3.036 (1.101 to 7.966) in the tribal land playgrounds compared to St. George parks. These findings support previous studies showing that areas in lower socioeconomic communities, especially marginalized communities, tend to have higher presence of parasites in the soil that may lead to higher rates of disease prevalence.

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Section: Textmentioning

confidence: 99%

Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area

McKim,

Kopystynsky,

Wolf

et al. 2023

Preprint

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“…Certain populations are especially vulnerable to incurring medical debt. These populations include racial and ethnic minority individuals, female individuals, younger individuals, rural residents, those with multiple chronic diseases or serious psychological distress, uninsured individuals, those with high-deductible insurance plans, individuals with limited health insurance literacy, and individuals living in states that have not expanded Medicaid income eligibility under the Patient Protection and Affordable Care Act (ACA) . Medical debt is adversely associated with multiple aspects of well-being, including delaying and forgoing recommended health care, prescription medication nonadherence, and food and housing insecurity .…”

Section: Introductionmentioning

confidence: 99%

“…These populations include racial and ethnic minority individuals, female individuals, younger individuals, rural residents, those with multiple chronic diseases or serious psychological distress, uninsured individuals, those with high-deductible insurance plans, individuals with limited health insurance literacy, and individuals living in states that have not expanded Medicaid income eligibility under the Patient Protection and Affordable Care Act (ACA). 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 Medical debt is adversely associated with multiple aspects of well-being, including delaying and forgoing recommended health care, prescription medication nonadherence, 21 , 22 , 23 and food and housing insecurity. 4 , 24 , 25 Through worsening of individual social risk factors and adversely affecting community social determinants of health, medical debt may exacerbate existing health disparities.…”

Section: Introductionmentioning

confidence: 99%

Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US

Han,

Hu,

Zheng

et al. 2024

JAMA Netw Open

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ImportanceMedical debt is increasingly common in the US. Little is known regarding its association with population health.ObjectiveTo examine the associations of medical debt with health status, premature death, and mortality at the county level in the US.Design, Setting, and ParticipantsThis cross-sectional study was conducted at the US county level using 2018 medical debt data from the Urban Institute Debt in America project linked with 2018 data on self-reported health status and premature death from the County Health Rankings &amp; Roadmaps and with 2015 to 2019 mortality data from the National Center for Health Statistics. Data analysis was performed from August 2022 to May 2023.ExposureShare of population with any medical debt in collections and median amount of medical debt.Main Outcomes and MeasuresHealth status was measured as (1) the mean number of physically and mentally unhealthy days in the past 30 days per 1000 people, (2) the mean number of premature deaths measured as years of life lost before age 75 years per 1000 people, and (3) age-adjusted all-cause and 18 cause-specific mortality rates (eg, malignant cancers, heart disease, and suicide) per 100 000 person-years. Multivariable linear models were fitted to estimate the associations between medical debt and health outcomes.ResultsA total of 2943 counties were included in this analysis. The median percentage of the county population aged 65 years or older was 18.3% (IQR, 15.8%-20.9%). Across counties, a median 3.0% (IQR, 1.2%-11.9%) of the population were Black residents, 4.3% (IQR, 2.3%-9.7%) were Hispanic residents, and 84.5% (IQR, 65.7%-93.3%) were White residents. On average, 19.8% (range, 0%-53.6%) of the population had medical debt. After adjusting for county-level sociodemographic characteristics, a 1–percentage point increase in the population with medical debt was associated with 18.3 (95% CI, 16.3-20.2) more physically unhealthy days and 17.9 (95% CI, 16.1-19.8) more mentally unhealthy days per 1000 people during the past month, 1.12 (95% CI, 1.03-1.21) years of life lost per 1000 people, and an increase of 7.51 (95% CI, 6.99-8.04) per 100 000 person-years in age-adjusted all-cause mortality rate. Associations of medical debt and elevated mortality rates were consistent for all leading causes of death, including cancer (1.12 [95% CI, 1.02-1.22]), heart disease (1.39 [95% CI, 1.21-1.57]), and suicide (0.09 [95% CI, 0.06-0.11]) per 100 000 person-years. Similar patterns were observed for associations between the median amount of medical debt and the aforementioned health outcomes.Conclusions and RelevanceThese findings suggest that medical debt is associated with worse health status, more premature deaths, and higher mortality rates at the county level in the US. Therefore, policies increasing access to affordable health care, such as expanding health insurance coverage, may improve population health.

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Falling Short: Examining Medical Debt and Cost Avoidance in American Indian and Alaska Native Households

Cited by 2 publications

References 0 publications

Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area

Environmental detection of parasites in the marginalized Paiute reservations compared to a nearby area

Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US

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