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. 2016 Jun;106(6):1086-91.
doi: 10.2105/AJPH.2016.303137. Epub 2016 Apr 14.

Medical Debt and Related Financial Consequences Among Older African American and White Adults

Jacqueline C Wiltshire  1 , Keith Elder  1 , Catarina Kiefe  1 , Jeroan J Allison  1
Affiliations

Medical Debt and Related Financial Consequences Among Older African American and White Adults

Jacqueline C Wiltshire et al. Am J Public Health. 2016 Jun.

Abstract

Objectives: To evaluate African American-White differences in medical debt among older adults and the extent to which economic and health factors explained these.

Methods: We used nationally representative data from the 2007 and 2010 US Health Tracking Household Survey (n = 5838) and computed population-based estimates of medical debt attributable to economic and health factors with adjustment for age, gender, marital status, and education.

Results: African Americans had 2.6 times higher odds of medical debt (odds ratio = 2.62; 95% confidence interval = 1.85, 3.72) than did Whites. Health status explained 22.8% of the observed disparity, and income and insurance explained 19.4%. These factors combined explained 42.4% of the observed disparity. In addition, African Americans were more likely to be contacted by a collection agency and to borrow money because of medical debt, whereas Whites were more likely to use savings.

Conclusions: African Americans incur substantial medical debt compared with Whites, and more than 40% of this is mediated by health status, income, and insurance disparities. Public health implications. In Medicare, low-income beneficiaries, especially low-income African Americans with poor health status, should be protected from the unintended financial consequences of cost-reduction strategies.

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Figures

FIGURE 1—
FIGURE 1—
Proposed Mediation Pathways Linking African American Race/Ethnicity With Medical Debt: 2007 and 2010 US Health Tracking Household Survey, Respondents Aged 65 Years or Older Note. All standardized path coefficients are adjusted for age, gender, marital status, and education.
See this image and copyright information in PMC

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