Medical Debt and Morbidity and Mortality among Rural and Urban Counties

Medical debt is prevalent in the U.S., and the relationship between medical debt and geographical health inequities remains underexplored. Using 2022 cross-sectional county-level data from the Urban Institute Debt in America project linked with County Health Rankings data, we assessed how having medical debt in collections is associated with six population morbidity and mortality outcomes by rural/urban location: fair/poor health, frequent mental or physical distress, life expectancy, and two premature mortality measures. A higher share of the population with medical debt was associated with worse population health across all six outcomes. Associations between increased medical debt and certain poorer health outcomes are somewhat more pronounced in urban counties than in rural counties, differences that remain for the three mortality outcomes even after adjusting for lower rural average household income. Our findings highlight the continuing need to reduce medical debt as a health equity issue across both rural and urban areas.