Cross-sectional study of association between medical debt and advanced cancer stage at diagnosis in the United States

Medical debt affects millions of US residents and has been associated with higher cancer mortality. Whether medical debt burden is associated with the incidence of advanced stage cancer at diagnosis is not clear. A cross-sectional study using ecological county-level data examined the association between medical debt and advanced cancer stage at diagnosis of 9 cancer types from 2017 to 2021. The study included 2958 US counties with available data on medical debt in collections and cancer incidence rates. Higher burden of medical debt was associated with a significantly increased incidence of late-stage lung, colorectal, cervical, melanoma, kidney, bladder, and head and neck cancers. Each 10-percentage point increase in medical debt was associated with 5.15 additional late-stage lung cancer cases per 100.000 person-years, with similar increases for other cancers. The authors conclude that these findings suggest that medical debt may reflect structural barriers to timely cancer detection and is associated with more advanced stage cancer diagnosis at the population level.