家庭经济安全和医疗债务：2019冠状病毒病大流行的教训。

IF 3.2 3区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health Pub Date : 2026-04-01 Epub Date: 2026-02-06 DOI:10.1016/j.puhe.2026.106173

Irina B. Grafova, Sharifa Z. Williams

{"title":"家庭经济安全和医疗债务：2019冠状病毒病大流行的教训。","authors":"Irina B. Grafova, Sharifa Z. Williams","doi":"10.1016/j.puhe.2026.106173","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>To examine how household medical debt responds to changes in income and new health events.</div></div><div><h3>Study design</h3><div>Secondary analysis of a panel survey.</div></div><div><h3>Methods</h3><div>We analyzed data from 6,599 households in the 2019–2021 waves of the nationally representative US Panel Study of Income Dynamics (PSID) with no medical debt in 2019. We focus on the onset of unpaid medical bills, classifying debt ≥20 % of annual income as high burden and <20 % as low or medium. Using logistic regression, we estimate the impact of changes in household income and onset of chronic conditions on acquiring medical debt.</div></div><div><h3>Results</h3><div>In our analytic sample, 4.4 % of households experienced the onset of low or medium medical debt, and 1.2 % experienced the onset of high medical debt between the 2019 and 2020 waves of the PSID. Pandemic-related earnings loss increased high medical debt onset by 1.1 percentage points (95 % confidence intervals [95 % CI: 0.2 to 1.9]). The onset of low or medium medical debt rose by 3.4 percentage points (95 % CI: 0.4 to 6.4) among households in which the head or spouse received a new diabetes diagnosis, and by 3.5 percentage points (95 % CI: 1.4 to 5.6) among households with a new arthritis diagnosis. High medical debt onset increased by 1.8 percentage points (95 % CI: 0.2 to 3.3) in households with a new cancer diagnosis.</div></div><div><h3>Conclusions</h3><div>Unexpected earnings losses and new diagnoses of cancer, diabetes, and arthritis significantly increase the risk of medical debt onset.</div></div>","PeriodicalId":49651,"journal":{"name":"Public Health","volume":"253 ","pages":"Article 106173"},"PeriodicalIF":3.2000,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Household economic security and medical debt onset: Lessons from the COVID-19 pandemic\",\"authors\":\"Irina B. Grafova, Sharifa Z. Williams\",\"doi\":\"10.1016/j.puhe.2026.106173\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>To examine how household medical debt responds to changes in income and new health events.</div></div><div><h3>Study design</h3><div>Secondary analysis of a panel survey.</div></div><div><h3>Methods</h3><div>We analyzed data from 6,599 households in the 2019–2021 waves of the nationally representative US Panel Study of Income Dynamics (PSID) with no medical debt in 2019. We focus on the onset of unpaid medical bills, classifying debt ≥20 % of annual income as high burden and <20 % as low or medium. Using logistic regression, we estimate the impact of changes in household income and onset of chronic conditions on acquiring medical debt.</div></div><div><h3>Results</h3><div>In our analytic sample, 4.4 % of households experienced the onset of low or medium medical debt, and 1.2 % experienced the onset of high medical debt between the 2019 and 2020 waves of the PSID. Pandemic-related earnings loss increased high medical debt onset by 1.1 percentage points (95 % confidence intervals [95 % CI: 0.2 to 1.9]). The onset of low or medium medical debt rose by 3.4 percentage points (95 % CI: 0.4 to 6.4) among households in which the head or spouse received a new diabetes diagnosis, and by 3.5 percentage points (95 % CI: 1.4 to 5.6) among households with a new arthritis diagnosis. High medical debt onset increased by 1.8 percentage points (95 % CI: 0.2 to 3.3) in households with a new cancer diagnosis.</div></div><div><h3>Conclusions</h3><div>Unexpected earnings losses and new diagnoses of cancer, diabetes, and arthritis significantly increase the risk of medical debt onset.</div></div>\",\"PeriodicalId\":49651,\"journal\":{\"name\":\"Public Health\",\"volume\":\"253 \",\"pages\":\"Article 106173\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2026-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Public Health\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0033350626000429\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2026/2/6 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Public Health","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0033350626000429","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/2/6 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH","Score":null,"Total":0}

引用次数: 0

摘要

目的：研究家庭医疗债务如何响应收入和新的健康事件的变化。研究设计：小组调查的二次分析。方法：我们分析了2019-2021年全国代表性美国收入动态小组研究（PSID）中6599个家庭的数据，这些家庭在2019年没有医疗债务。我们关注未付医疗账单的开始，将债务≥年收入的20%归类为高负担。结果：在我们的分析样本中，4.4%的家庭经历了低或中等医疗债务的开始，1.2%的家庭经历了2019年至2020年PSID浪潮期间的高医疗债务的开始。与大流行相关的收入损失使高额医疗债务增加了1.1个百分点（95%置信区间[95% CI: 0.2至1.9]）。在户主或配偶新诊断为糖尿病的家庭中，低或中等医疗债务的发生率上升了3.4个百分点（95%可信区间：0.4至6.4），在新诊断为关节炎的家庭中，这一数字上升了3.5个百分点（95%可信区间：1.4至5.6）。在新诊断出癌症的家庭中，高医疗债务发生率增加了1.8个百分点（95% CI: 0.2至3.3）。结论：意外收入损失和新诊断的癌症、糖尿病和关节炎显著增加了医疗债务发作的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Household economic security and medical debt onset: Lessons from the COVID-19 pandemic

Objectives

To examine how household medical debt responds to changes in income and new health events.

Study design

Secondary analysis of a panel survey.

Methods

We analyzed data from 6,599 households in the 2019–2021 waves of the nationally representative US Panel Study of Income Dynamics (PSID) with no medical debt in 2019. We focus on the onset of unpaid medical bills, classifying debt ≥20 % of annual income as high burden and <20 % as low or medium. Using logistic regression, we estimate the impact of changes in household income and onset of chronic conditions on acquiring medical debt.

Results

In our analytic sample, 4.4 % of households experienced the onset of low or medium medical debt, and 1.2 % experienced the onset of high medical debt between the 2019 and 2020 waves of the PSID. Pandemic-related earnings loss increased high medical debt onset by 1.1 percentage points (95 % confidence intervals [95 % CI: 0.2 to 1.9]). The onset of low or medium medical debt rose by 3.4 percentage points (95 % CI: 0.4 to 6.4) among households in which the head or spouse received a new diabetes diagnosis, and by 3.5 percentage points (95 % CI: 1.4 to 5.6) among households with a new arthritis diagnosis. High medical debt onset increased by 1.8 percentage points (95 % CI: 0.2 to 3.3) in households with a new cancer diagnosis.

Conclusions

Unexpected earnings losses and new diagnoses of cancer, diabetes, and arthritis significantly increase the risk of medical debt onset.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Public Health 医学-公共卫生、环境卫生与职业卫生

CiteScore

7.60

自引率

0.00%

发文量

280

审稿时长

37 days

期刊介绍： Public Health is an international, multidisciplinary peer-reviewed journal. It publishes original papers, reviews and short reports on all aspects of the science, philosophy, and practice of public health.