Association Between Medical Debt and Vaccine Uptake in the USA, 2021-2022.

Abstract

Background: Many individuals do not receive recommended vaccines, increasing infectious disease morbidity and mortality. It is unknown whether the financial practices of US healthcare institutions contribute to vaccine hesitancy.

Objective: To determine whether medical debt is associated with low vaccine uptake.

Design: Cross-sectional analysis of the association between medical debt and vaccine receipt.

Subjects: 56,373 adult participants in the 2021-2022 National Health Interview Survey.

Interventions: Presence of medical debt at the time of survey administration.

Main measures: We used logistic regression models to assess whether medical debt was associated with recent vaccine receipt, adjusting for sociodemographic, health, and access-to-care variables. We performed a sensitivity analysis restricted to individuals with health insurance and conducted a falsification test of the hypothesis that current medical debt would not be associated with remote prior vaccination (i.e., > 1 year prior, likely before debt acquisition).

Key results: Individuals with medical debt were less likely than those without such debt to receive any recent vaccine (adjusted odds ratio [aOR] 0.83, 95% confidence interval [CI] 0.76-0.91), including influenza vaccination (aOR 0.83, 95% CI 0.75-0.91) or COVID-19 vaccination (aOR 0.79, 95% CI 0.69-0.91). Analyses limited to insured individuals had similar findings (aOR for any recent vaccination 0.79, 95% CI 0.72-0.88). In the falsification test, current medical debt was not associated with remote prior vaccination (aOR 1.04, 95% CI 0.93-1.16).

Conclusions: Current medical debt is associated with lower likelihood of recent vaccine receipt in both insured and uninsured individuals. Policies that minimize medical debt may improve vaccine coverage.