title: A National study of burdensome health care costs among non-elderly Americans.
abstract: BACKGROUND
  Rising health care costs and increased cost sharing have resulted in significant medical expenses for many Americans. The goal of this study was to describe the prevalence of and risk factors for burdensome health care costs among non-elderly Americans.
  
  
  METHODS
  This was a cross sectional study of a nationally representative sample of non-elderly Americans. We used survey data previously collected by the Kaiser Family Foundation. We used logistic regression to identify key risk factors for burdensome health care costs and to assess whether risk factors differ according to age within our study population. For analyses comparing younger and middle-aged adults, we compared participants ages 18-39 (younger Americans) to those ages 40-64 (middle-aged Americans).
  
  
  RESULTS
  Our study population included 5,493 participants. Twenty seven percent of participants reported difficulty paying medical bills, a prevalence that did not differ by age. Low income, lack of health insurance, and poor health were independently associated with difficulty paying medical bills after controlling for demographic covariates. Both younger and middle-aged adults were likely to experience burdensome health care costs at low incomes. At moderate incomes, risk fell for middle-aged adults, but remained high for younger adults (ORmiddle-age 1.40, 95% CI 1.12-1.75, ORyounger 2.48, 95% CI 1.73-3.57, p value for interaction 0.004). Younger adults without insurance were at risk for accruing burdensome costs compared to their insured counterparts (OR 2.61, 95% CI 1.96-3.47). Middle-aged adults without insurance, though, had an even higher risk (OR 3.82, 95% CI 2.93-4.97, p value for interaction 0.037).
  
  
  CONCLUSIONS
  Both younger and middle-aged adults commonly report difficulty paying medical bills. Younger adults remain vulnerable to burdensome medical costs even when earning moderate incomes. Middle-aged adults, however, are more likely to encounter burdensome costs when uninsured. These findings suggest that younger and middle-aged adults experience distinct vulnerabilities and may benefit differentially from health reform efforts intended to expand coverage and limit out-of-pocket expenses.
authors.affiliation: Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, CA, USA. ilana.richman@gmail.com.
authors.forename: Ilana B
authors.initials: IB
authors.lastname: Richman
authors.forename: Mollyann
authors.initials: M
authors.lastname: Brodie
mesh_terms: D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D005382:Financing, Personal; D017048:Health Care Costs / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult