{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T06:23:09Z","timestamp":1777357389700,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"21","license":[{"start":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T00:00:00Z","timestamp":1761436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The high costs of cancer care may lead to medical debt for patients and families. This study examined the association of county\u2010level medical debt and timely treatment initiation among individuals newly diagnosed with cancer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Individuals aged 19 years and older who were newly diagnosed with acute leukemias, diffuse large B\u2010cell lymphoma, Hodgkin lymphoma, female breast cancer, colorectal cancer, and lung cancer with consecutive enrollment in the same insurance type from the month of diagnosis through 90 days afterward were identified from the 2012\u20132021 Colorado Central Cancer Registry linked to the Colorado All\u2010Payer Claims Database with information about county\u2010level medical debt from the Urban Institute (\n                      <jats:italic>N<\/jats:italic>\n                      \u00a0=\u00a035,789). The exposure was the county\u2010level share of adults with medical debt in collections, categorized in four quartiles (Q1\u2013Q4). The outcome was timely treatment initiation\u2014defined as the receipt of any cancer\u2010directed treatment within 90 days after cancer diagnosis. The association of county\u2010level medical debt and time to treatment initiation was examined by using multivariable Cox models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher county\u2010level medical debt was associated with lower likelihood of timely treatment initiation for all selected cancers combined (Q4 [counties with the highest medical debt rate;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a08652] vs. Q1 [counties with the lowest medical debt rate;\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a09042]: hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.871\u20130.963;\n                      <jats:italic>p<\/jats:italic>\n                      for trend\u00a0=\u00a0.001), for female breast cancer (Q4 vs. Q1: HR, 0.910; 95% CI, 0.847\u20130.978;\n                      <jats:italic>p<\/jats:italic>\n                      for trend\u00a0=\u00a0.011), and among individuals aged 19\u201364 years with private health maintenance organization plans (Q4 vs. Q1: HR, 0.790; 95% CI, 0.699\u20130.893;\n                      <jats:italic>p<\/jats:italic>\n                      for trend\u00a0=\u00a0.002) or Medicaid coverage (Q4 vs. Q1: HR, 0.869; 95% CI, 0.786\u20130.960;\n                      <jats:italic>p<\/jats:italic>\n                      for trend\u00a0=\u00a0.013).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely treatment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.70133","type":"journal-article","created":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T08:00:36Z","timestamp":1761465636000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["County\u2010level medical debt and treatment initiation among individuals newly diagnosed with cancer"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2733-2000","authenticated-orcid":false,"given":"Jingxuan","family":"Zhao","sequence":"first","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research American Cancer Society  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3355-3720","authenticated-orcid":false,"given":"Marcelo","family":"Perraillon","sequence":"additional","affiliation":[{"name":"Colorado School of Public Health University of Colorado Comprehensive Cancer Center  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxanne M.","family":"Clark","sequence":"additional","affiliation":[{"name":"School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel J.","family":"Greenwald","sequence":"additional","affiliation":[{"name":"School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel A.","family":"Pollyea","sequence":"additional","affiliation":[{"name":"Division of Hematology University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7159-7949","authenticated-orcid":false,"given":"Xuesong","family":"Han","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research American Cancer Society  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0644-5572","authenticated-orcid":false,"given":"K. Robin","family":"Yabroff","sequence":"additional","affiliation":[{"name":"Surveillance, Prevention, and Health Services Research American Cancer Society  Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathy J.","family":"Bradley","sequence":"additional","affiliation":[{"name":"Colorado School of Public Health University of Colorado Comprehensive Cancer Center  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3822-9858","authenticated-orcid":false,"given":"Helen M.","family":"Parsons","sequence":"additional","affiliation":[{"name":"School of Public Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,10,26]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"SoniA Statistical Brief #470.Trends in the Five Most Costly Conditions among the U.S. Civilian Noninstitutionalized Population 2002 and 2012. 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