People with medical debt are significantly more likely to experience subsequent housing instability such as difficulty with rent or mortgage payments, eviction, or foreclosure, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.
Survey participants who reported having medical debt in 2024 had—after adjusting for a set of potential confounding factors—a seven-percentage-point-higher chance on average of reporting housing instability in 2025, compared to those not reporting medical debt. This translates to a 44% higher risk of housing instability among those with medical debt.
The study adds to growing evidence of the adverse consequences of medical debt in the U.S. The findings are drawn from responses from 1,515 U.S. adults who participated in a nationally representative annual survey from 2023 to 2025.
About 1 in 6 reported having medical debt in 2024, and about 1 in 12 reported housing instability in 2025: 240 participants reported having medical debt in 2024, with 60 reporting housing instability in 2025. Renters were disproportionately impacted by medical debt, representing 2 in 5 adults with medical debt in 2025.
The study was published online January 12 in JAMA Network Open.
“Given what we know about the importance of housing for health, these findings suggest that for many people, receiving health care can lead to medical debt, and then to housing instability,” says study first author Kyle Moon, a PhD candidate in the Bloomberg School’s Department of Mental Health. “This can create a cascade of consequences, including delayed health care, that jeopardizes health.”
Moon is a member of the research team led by study senior author Catherine Ettman, PhD, an assistant professor in the Bloomberg School’s Department of Health Policy and Management. Ettman’s team examines the public health impacts of socioeconomic stressors.
Health care in the U.S. can be expensive even for those with health insurance, and medical debt affects tens of millions of American households. Earlier this year, Ettman and colleagues published a study linking medical debt to forgoing mental health care in the subsequent year. Prior research has linked medical debt to forgoing health care.
The new analysis used data from the Cumulative Life Stressors Impact on Mental Health and Well Being (CLIMB) Study. Initially set up by Ettman and colleagues in 2020 to help gauge mental health impacts of the COVID-19 pandemic, the nationally representative survey now tracks American health and associated socioeconomic factors. The CLIMB study surveys participants each spring. The analysis focused on answers provided in the 2023, 2024, and 2025 surveys.
For their analysis, the researchers identified 1,515 participants who answered the relevant survey questions all three years. They used the 2024 answers to group respondents by medical debt status, the 2025 answers to gauge their rates of housing instability, and the 2023 answers to establish participants’ baseline characteristics such as household income, savings, health insurance coverage, age, sex, and race. Most participants were white homeowners with more than $60,000 annual household income.
“This analysis weaves together two important drivers of affordability in the United States and suggests that medical debt is linked with housing instability, which we know could have further influence on health outcomes,” Ettman says.
The team is continuing to research the relationships between economic and financial factors and health in U.S. households, using the ongoing CLIMB study and other resources.
“Housing Instability Following Medical Debt Exposure Among U.S. Adults, 2023 to 2025” was co-authored by Kyle Moon, Sabriya Linton, Elizabeth Stuart, Sandro Galea and Catherine Ettman.
Support for the research was provided in part by a Nexus Award from the Johns Hopkins University. The CLIMB Study 2023–25 was funded in part by a grant from the de Beaumont Foundation. Moon was supported by a training grant from the National Institute on Drug Abuse (5T32DA007292).
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Journal
JAMA Network Open