This dataset contains information on medical debt in collections at the national, state, and county levels from 2011 to 2023. It includes data on hospital market concentration, hospital closures and mergers, uninsured population, disabled adults, and average household income. The data is derived from the Urban Institute Credit Bureau Panel, the American Hospital Association Annual Survey Database, the CMS Provider of Services File, and the American Community Survey.

Our medical debt estimates are derived from the Urban Institute Credit Bureau Panel. The panel contains annual data collected from August 2011 through August 2023, which consists of a 2 percent random sample of consumers in each year from 2011 through 2019 (i.e., more than 5 million consumers in each year) and a 4 percent random sample from 2020 through 2023 (i.e., more than 10 million consumers). Hospital market concentration estimates are derived from the American Hospital Association Annual Survey Database. Closures and mergers data are derived from the Provider of Services File provided by the Centers for Medicare & Medicaid Services. The estimates of uninsured, disabled adults, average household income, and racial composition are from the US Census Bureau’s American Community Survey (ACS) summary tables. We use ACS one-year estimates for state—and national-level statistics, but we use the ACS five-year estimates for counties and zip code tabulation area-level information.

Because the credit bureau data do not include information about race and ethnicity, the medical debt measures for white communities and communities of color are based on the racial makeup of zip code tabulation areas (ZCTAs) within the geographic area (nation, state, and county). The white community values are based on credit records of people who live in ZCTAs where at least 50 percent of the population is white non-Hispanic. Communities of color values are based on credit records of people who live in ZCTAs where at least 50 percent of the population is African American, Hispanic, Asian or Pacific Islander, American Indian or Alaska Native, another race other than white, or multiracial.

Credit bureau data are reported at the national, state, and county levels for the 50 states and Washington, DC. The downloadable dataset notes missing and unavailable values with “NA.” Some values are unavailable because credit bureau metrics are not reported when based on fewer than 50 people. In other cases, values for white communities and communities of color are not reported because there are no ZCTAs with a majority population of white residents or a majority population of color in the county or state.

For more information, please see the technical appendix.