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

Importance: Medical debt may place patients at heightened risk of housing instability as a result of increased financial strain or extraordinary collection actions. Objective: To estimate the association of medical debt with housing instability in the subsequent year. Design, Setting, and Participants: 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. Exposures: Past-year medical debt self-reported in 2024. Main Outcomes and Measures: 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. Results: 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. Conclusions and Relevance: 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.