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Medical Debt and Related Financial Consequences Among Older African American and White Adults
University of Massachusetts Medical School Faculty Publications
  • Jacqueline C. Wiltshire, University of South Florida
  • Keith Elder, Saint Louis University
  • Catarina I. Kiefe, University of Massachusetts Medical School
  • Jeroan J. Allison, University of Massachusetts Medical School
UMMS Affiliation
Department of Quantitative Health Sciences
Publication Date
Document Type

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.

DOI of Published Version
Am J Public Health. 2016 Jun;106(6):1086-91. doi: 10.2105/AJPH.2016.303137. Epub 2016 Apr 14. Link to article on publisher's site
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Citation Information
Jacqueline C. Wiltshire, Keith Elder, Catarina I. Kiefe and Jeroan J. Allison. "Medical Debt and Related Financial Consequences Among Older African American and White Adults" Vol. 106 Iss. 6 (2016) ISSN: 0090-0036 (Linking)
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