Medical debt is associated with higher sugar-sweetened beverage consumption among U.S. adults

Medical debt is associated with poor mental and physical health outcome among US adults. Extant evidence also suggests an association between psychological distress and sugar-sweetened beverage (SSB) consumption. Building on these two strands of literature, this paper aimed to assess whether medical debt, defined as inability to pay medical bills, was associated with higher SSB consumption in US adults.

Using data on 26,559 adults from the 2022 National Health Interview Survey, we estimated two-part models to assess aggregate monthly frequency of SSB consumption. We used logistic regression to model the binary consumption decision (first part) and a generalized linear model (GLM) with log link and Poisson distribution to model the continuous frequency of consumption (second part). Adjustments were made for demographic, socioeconomic, and other known determinants of SSB consumption along with interview month fixed effects.

Around 10.6% of the adults in our sample had medical debt and 6.4% were unable to pay at all. Those who had medical debt were more likely to consume SSBs at both external (i.e., whether consumed) and internal (how much if consumed) margins. On average, frequency of monthly SSB consumption was 4.07 (95% CI: 1.13-7.00) and 6.61 (95% CI: 2.74-10.49) units higher among adults with medical debt in general and those who were unable to pay, respectively, compared to that of adults who did not have problems paying medical bills.

These results suggest that US adults with medical debt were more likely to consume SSBs and warrants further research to identify strategies for curbing SSB consumption in this population.