{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T16:03:17Z","timestamp":1790870597265,"version":"4.1.0"},"reference-count":62,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Medical debt affects millions of US residents and has been associated with higher cancer mortality. Whether medical debt burden is associated with incidence of advanced stage cancer, a key determinant of survival, remains unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine the association between medical debt and cancer incidence in the US.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study used ecological county-level data linking 2016 medical debt with age-adjusted incidence rates of 9 cancers from January 1, 2017, to December 31, 2021. The study included 2958 US counties with available data on medical debt in collections and cancer incidence rates. Population-based data were obtained and analyzed from January 11, 2025, to February 15, 2026.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Percentage of residents with any medical debt in collections in 2016.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Age-adjusted all-stage and late-stage (regional or distant) cancer incidence rates per 100\u202f000 person-years from 2017 to 2021. Multivariable models adjusted for urban-rural status, Social Vulnerability Index (SVI), primary care physician density, and states were used to estimate differences in age-adjusted incidence rates of cancer associated with county-level medical debt burden.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among the 2958 US counties included in the analysis, 1154 (39.0%) were urban and 1804 (61.0%) were rural. The mean (SD) prevalence of medical debt in collections was 21.1% (9.6%), with a mean (SD) primary care physician density of 0.54 (0.35) physicians per 1000 population. The prevalence of medical debt ranged from 1.2% to 51.8%. The mean (SD) medical debt prevalence was higher in rural than urban counties (21.5% [10.0%] vs 20.5% [8.9%];\n P<\/jats:italic>\n \u2009=\u2009.007) and in counties in the highest vs lowest SVI quartile (27.4% [9.0%] vs 13.9% [6.9%];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). After adjustment, each 10percentage point increase in county-level medical debt was associated with a higher incidence of late-stage lung cancer (5.15 [95% CI, 4.62-5.68] additional cases per 100\u202f000 person-years), colorectal cancer (0.69 [95% CI, 0.44-0.94] additional cases per 100\u202f000 person-years), cervical cancer (0.39 [95% CI, 0.23-0.55] additional cases per 100\u202f000 person-years), melanoma (0.59 [95% CI, 0.48-0.70] additional cases per 100\u202f000 person-years), kidney and renal pelvis cancer (0.38 [95% CI, 0.27-0.49] additional cases per 100\u202f000 person-years), bladder cancer (0.24 [95% CI, 0.16-0.32] additional cases per 100\u202f000 person-years), and head and neck cancer (0.92 [95% CI, 0.77-1.07] additional cases per 100\u202f000 person-years). Similar patterns were observed for overall cancer incidence.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of US counties, higher medical debt burden was associated with higher incidence rates of late-stage and overall cancer across multiple cancer types. These findings suggest that medical debt may reflect structural and financial barriers associated with cancer diagnosis and outcomes at the population level.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.37508","type":"journal-article","created":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T15:44:07Z","timestamp":1790869447000},"page":"e2637508","source":"Crossref","is-referenced-by-count":0,"title":["Medical Debt and Advanced Cancer Stage at Diagnosis"],"prefix":"10.1001","volume":"9","author":[{"given":"Jiazhang","family":"Xing","sequence":"first","affiliation":[{"name":"Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingbin","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, The Ohio State University Wexner Medical Center, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lang","family":"Qu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Sinai Hospital of Baltimore, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan D.","family":"Nipp","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Section of Hematology\/Oncology, University of Oklahoma Health and Stephenson Cancer Center, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Department of Surveillance, Prevention and Health Services Research, American Cancer Society, Atlanta, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Changchuan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,10,1]]},"reference":[{"issue":"3","key":"zoi261008r1","doi-asserted-by":"publisher","first-page":"250","DOI":"10.1001\/jama.2021.8694","article-title":"Medical debt in the US, 2009-2020.","volume":"326","author":"Kluender","year":"2021","journal-title":"JAMA"},{"issue":"7","key":"zoi261008r2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.19763","article-title":"Lawsuits for unpaid medical bills and the role of 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