Housing Instability Following Medical Debt Exposure Among US Adults, 2023 to 2025

TL;DR

Medical debt increases the risk of housing instability for US adults, according to a study of 1515 participants from 2023 to 2025.

Contribution

The study provides new evidence that medical debt is linked to a 7-percentage point rise in housing instability.

Findings

240 out of 1515 adults (16.4%) reported medical debt in 2024.

Medical debt was associated with a 7.0 percentage point increase in housing instability the following year.

Housing instability was more common among those with medical debt (23.5%) than those without (5.8%).

Abstract

This cohort study evaluates the association between medical debt and housing instability in the subsequent year.

Is medical debt associated with housing instability?

This nationally representative cohort study of 1515 US adults estimated that any medical debt was associated with a 7–percentage point increase in the probability of experiencing housing instability in the subsequent year.

These findings suggest medical debt undermines assets and imperils future housing stability, which may, in turn, worsen health for adults carrying medical debt.

Medical debt may place patients at heightened risk of housing instability as a result of increased financial strain or extraordinary collection actions.

To estimate the association of medical debt with housing instability in the subsequent year.

Cohort study in the US from 2023 to 2025 including adults participating in the Cumulative Life Stressors Impact on Mental Health and Well Being Study, a nationally representative, longitudinal panel.

Past-year medical debt self-reported in 2024.

Past-year housing instability (ie, difficulty paying rent or mortgage, eviction, or foreclosure) self-reported in 2025. Propensity score weighting was used to account for differences between adults with and without medical debt, using data from the year before medical debt (2023). Survey weights were used to account for complex survey design.

Among 1515 adults (mean [SD] age, 52.2 [16.2] years; 739 [49.7%] female; 138 [11.5%] Black, 203 [15.1%] Latine, and 1082 [65.0%] non-Hispanic White), 240 (16.4%) reported medical debt in 2024. The unadjusted prevalence of subsequent housing instability was markedly higher among adults with medical debt, compared with those without medical debt (23.5%; 95% CI, 18.2%-29.9% vs 5.8%; 95% CI, 3.6%-9.4%). Using doubly robust estimation to adjust for confounders, medical debt was associated with an increase of 7.0 (95% CI, 5.2-8.8) percentage points in the probability of housing instability in the subsequent year.

This cohort study found that any medical debt was associated with a significant increase in housing instability in the following year. Inquiry into efforts to prevent and mitigate the potential consequences of medical debt, including housing instability, are warranted.

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