title: Medical Debt and Related Financial Consequences Among Older African American and White Adults.
abstract: To evaluate African American-White differences in medical debt among older adults and the extent to which economic and health factors explained these.
  
  
  
  We used nationally representative data from the 2007 and 2010 US Health Tracking Household Survey (n = 5838) and computed population-based estimates of medical debt attributable to economic and health factors with adjustment for age, gender, marital status, and education.
  
  
  
  African Americans had 2.6 times higher odds of medical debt (odds ratio = 2.62; 95% confidence interval = 1.85, 3.72) than did Whites. Health status explained 22.8% of the observed disparity, and income and insurance explained 19.4%. These factors combined explained 42.4% of the observed disparity. In addition, African Americans were more likely to be contacted by a collection agency and to borrow money because of medical debt, whereas Whites were more likely to use savings.
  
  
  
  African Americans incur substantial medical debt compared with Whites, and more than 40% of this is mediated by health status, income, and insurance disparities. Public health implications. In Medicare, low-income beneficiaries, especially low-income African Americans with poor health status, should be protected from the unintended financial consequences of cost-reduction strategies.
authors.affiliation: Jacqueline C. Wiltshire is with the Department of Health Policy and Management, University of South Florida College of Public Health, Tampa. Keith Elder is with the Department of Health Management and Policy, Saint Louis University School of Public Health, St Louis, MO. Jeroan J. Allison and Catarina Kiefe are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Wiltshire
authors.affiliation: Jacqueline C. Wiltshire is with the Department of Health Policy and Management, University of South Florida College of Public Health, Tampa. Keith Elder is with the Department of Health Management and Policy, Saint Louis University School of Public Health, St Louis, MO. Jeroan J. Allison and Catarina Kiefe are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Keith
authors.initials: K
authors.lastname: Elder
authors.affiliation: Jacqueline C. Wiltshire is with the Department of Health Policy and Management, University of South Florida College of Public Health, Tampa. Keith Elder is with the Department of Health Management and Policy, Saint Louis University School of Public Health, St Louis, MO. Jeroan J. Allison and Catarina Kiefe are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Catarina
authors.initials: C
authors.lastname: Kiefe
authors.affiliation: Jacqueline C. Wiltshire is with the Department of Health Policy and Management, University of South Florida College of Public Health, Tampa. Keith Elder is with the Department of Health Management and Policy, Saint Louis University School of Public Health, St Louis, MO. Jeroan J. Allison and Catarina Kiefe are with the Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester.
authors.forename: Jeroan J
authors.initials: JJ
authors.lastname: Allison
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000191:economics; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D007182:Income; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D010350:Patient Credit and Collection / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*