The Association of Childbirth with Medical Debt in the USA, 2019-2020.
Level 4 - case-series / case-control
Cross-sectional analysis of national survey data
PubMed 37199904 · doi:10.1007/s11606-023-08214-3
What was done
Researchers analyzed cross-sectional data from 12,163 female adults aged 18–49 in the 2019–2020 National Health Interview Survey. They evaluated associations between giving birth in the past year (n = 645) and two family-level medical debt outcomes: problems paying medical bills and inability to pay medical bills. Multivariable logistic regressions adjusted for confounders and examined associations with maternal asthma, hypertension, gestational diabetes, and sociodemographic factors.
What was found
Medical bill problems were reported by 19.8% of postpartum women versus 15.1% of non-postpartum women. In adjusted multivariable models, postpartum women had 48% higher odds of medical debt problems (95% CI 1.13, 1.92), with similar findings for inability to pay medical bills and within privately insured subgroups. Among postpartum women, lower income, asthma, and gestational diabetes—but not hypertension—were significantly associated with higher adjusted odds of medical debt problems.
Why it matters
Childbirth is a significant contributor to financial strain in the US, suggesting that existing insurance coverage leaves postpartum families, particularly those with lower incomes or chronic conditions, vulnerable to medical debt.
Limits
The cross-sectional design cannot establish causality or determine if debt existed prior to pregnancy. Debt outcomes and medical conditions were self-reported, specific dollar amounts were not captured, and the postpartum sample was relatively modest (n = 645).