U.S. health care workers carry significantly more medical and educational debt compared with other workers, collectively owing over $150 billion, according to a cross-sectional study conducted from 2018 to 2021.

The study, published in JAMA Health Forum, analyzed data from the Survey of Income and Program Participation (SIPP), a nationally representative longitudinal household panel. Researchers compared the medical and educational debt of 8,018 health care workers (weighted n = 12.6 million)—including physicians, registered nurses, nursing aides and assistants, and others—with 53,346 other workers (weighted n = 83.2 million).

Logistic regression models were used to estimate associations between medical and educational indebtedness and variables including sex, race/ethnicity, income, education, occupation, health care industry subsector, unionization status, health insurance, and recent hospitalization. SIPP-provided weights and survey procedures accounted for the sample design.

Following STROBE reporting guidelines, the researchers found that 13.9% of health care workers reported medical debt vs. 11.1% of other workers. Health care workers' mean medical debt was $1,567 (adjusted to 2021 dollars using the Consumer Price Index), totaling $19.8 billion nationally. Medical debt was more common among women than men (15.3% vs. 9.3%) and Black vs White workers (19.7% vs. 13.1%).

Educational debt was also more prevalent among health care workers compared with other workers (26.7% vs. 16.5%), with health care workers owing an average of $10,642 in educational debt, totaling $134.4 billion nationally. Black and younger health care workers, as well as those with higher education levels, were disproportionately burdened by educational debt.

Medical debt was associated with sex, income, education level, working in home health and nursing home care, lacking health insurance, and recent hospitalization. Adjusted odds ratios (aORs) for medical debt were:

• 1.36 for women vs. men
• 1.64 for income 200%-299% of the federal poverty level vs. < 100%
• 0.62 for bachelor's degree and 0.42 for graduate degree vs. high school or less
• 1.41 for nursing home and 1.65 for home health care vs. hospital workers
• 1.56 for uninsured vs. insured
• 2.78 for recently hospitalized vs. not.

Educational debt was more frequent among Black vs. White workers (aOR, 1.57), and those with higher education levels (aOR, 4.31 for bachelor's and 6.05 for graduate degree vs. high school or less). Odds decreased with age (aOR, 0.35 for ages 45-64 and 0.08 for ≥ 65 vs ≤ 44 years).

The authors noted that educational and medical debts are associated with adverse health outcomes and may limit health care workers' professional mobility, reduce workforce diversity, and discourage personnel from entering lower-paying fields like public health or primary care. They also highlighted that workers indebted to their employers may be less able to address patient safety concerns or workplace abuses.

Limitations of the study included potential recall bias from self-reported SIPP data and possible underestimation of debt size due to top coding of dollar amounts. SIPP lacked data on debt creditors, preventing analyses of whether workers owed debts to their employers.

The study was supported by grant T32AI007433 from the National Institute of Allergy and Infectious Diseases. Conflict of interest disclosures can be found in the study.