Association of medical debt with cancer incidence rates in the US.

Abstract

11012 Background: Medical debt is a growing challenge for U.S. patients and has been associated with higher cancer mortality. However, whether medical debt is associated with advanced-stage cancer diagnoses – a strong predictor of worse prognosis – remains unclear. This study investigated the association between medical debt in collections and overall and advanced stage cancer incidence rates in the U.S. Methods: We conducted an ecological study using 2019 county-level medical debt in collections data from the Urban Institute Debt in America project and age-adjusted cancer incidence rates (2017-2021) from the CDC State Cancer Profiles dataset. Outcomes were age-adjusted cancer incidence and age-adjusted late-stage (i.e., regional or distant) incidence rates for ten common cancers with screening tests or early signs. We used generalized linear mixed models, adjusting for urban-rural status, county-level Social Vulnerability Index, county population size, primary care physician density, median population age and state. Results: We included data from all 3,143 counties. The county-level percentage of medical debt in collections ranged from 0.0% to 23.5%. One percentage increase in medical debt was associated with a 74.80 (95% CI=43.45-106.19) increase in overall cancer incidence rate per 100,000 person-years. Regarding late-stage cancer incidence, one percentage increase in medical debt was associated with a 5.16 (95% CI=1.05-9.28) increase in late-stage incidence rate for colorectal, a 2.11 increase (95% CI=1.04-3.18) for bladder, a 2.73 (95% CI=1.08-4.39) increase for kidney and renal pelvis, a 28.69 (95% CI=22.22-35.17) for lung and bronchus, and a 0.14 (95% CI=0.01-0.26) increase for oral cavity and pharynx cancers, and a 2.99 (95% CI=1.53-4.44) increase for melanoma of the skin. No significant association was noticed in other cancer types. Conclusions: Medical debt in collections is associated with higher overall incidence and late-stage rates for multiple cancer types, suggesting financial barriers may impede both cancer screening and timely symptom evaluation. Adjusted association of percent of population with medical debt in collections with cancer incidence rate at the county level (per 100,000). Incidence Late stage incidence All cancers 74.80 (43.45-106.19) - Colorectal 9.48 (3.68-15.28) 5.16 (1.05-9.28) Kidney and renal pelvis 9.84 (6.48-13.22) 2.73 (1.08-4.39) Lung and bronchus 41.02 (32.46-49.58) 28.69 (22.22-35.17) Cervix 0.64(0.40-0.88) 0.17(0.00-0.34) Melanoma -5.73(-11.52-0.05) 2.99 (1.53-4.44) Bladder -0.73(-4.01-2.51) 2.11 (1.04-3.18) Prostate -13.70(-29.67-2.29) -5.28(-11.10-0.42) Breast -1.43(-13.83-10.89) 4.57(-1.71-10.88) Oral Cavity and Pharynx 0.16(0.01-0.31) 0.14(0.01-0.26) Data for late-stage incidence of all cancer sites combined not available from CDC.