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. 2025 Jan 21;87(2):663–672. doi: 10.1097/MS9.0000000000002865

Healthcare debts in the United States: a silent fight

Abdullahi Tunde Aborode a, Oreoluwa Oginni b, Modesta Abacheng c, Ottoho Edima d, Emily Lamunu e, Tayo Nafisat Folorunso f, Christian Inya Oko g, Akinjo Rebecca Iretiayo h, Lukman Lawal i,j, Ruth Amarachi k, Rawa Badri l,m, Gafar Babatunde Bamigbade n, Omotayo Faith Olanrewaju o, Favour Obianuju Agwuna o, Ridwan Olamilekan Adesola p,*
PMCID: PMC11918610  PMID: 40110309

Abstract

Healthcare debt in the United States is a significant problem, affecting millions of Americans. Many people struggle to pay for healthcare, and approximately 9% owe over $250 due to health costs. Nearly half of US adults find it difficult to afford healthcare, with uninsured individuals and those with lower incomes facing the most significant challenges. Healthcare debt in the United States is a problem with profound consequences. This debt encompasses expenses incurred for various medical services, from hospital stays and surgeries to doctor visits and medications. Healthcare debt casts a long shadow, adversely affecting physical and mental well-being and increasing stress, anxiety, and depression. Unpaid bills lead to the avoidance of necessary care, perpetuating health issues and straining the healthcare system. Beyond health implications, it affects credit history, limits access to credit facilities, and hampers employment opportunities. So, comprehensive healthcare reform emerges as a potential remedy, by expanding access to affordable health insurance, regulating healthcare costs, and addressing coverage gaps could alleviate the impact of healthcare debts. Therefore, exploring the feasibility of transitioning toward a universal healthcare system becomes crucial, offering equitable access to essential medical services and mitigating financial burdens on individuals. As healthcare debts continue to profoundly influence health, economic stability, and social well-being, a holistic approach is imperative for a healthier and economically sound future for all Americans.

Keywords: healthcare costs, healthcare debt, healthcare financial burden, health expenditure, out-of-pocket expenses, USA

Introduction

In the United States, healthcare debt is a serious problem that affects millions of Americans. It encompasses the accumulated financial obligations incurred for medical services by individuals or families, including hospital stays, surgical procedures, doctor visits, medicines, and associated costs [1]. Many of the US adult population faces challenges with covering healthcare costs. Although most of these are reported by adults with low incomes or without insurance, there is no guarantee that they will be immune to high healthcare costs, as shown in Fig. 1 [2]. A recent analysis of government data reveals that approximately 9% of adults (roughly 23 million people) owe over $250 in healthcare debt [3].

Figure 1.

Figure 1.

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The burden of healthcare debt in the United States[2].

A study [2] found that it is difficult for about half the US adults to afford healthcare costs, with 47% saying it is very or somewhat difficult. Uninsured adults under age 65 are significantly more likely to report difficulty affording healthcare costs (85%) compared to those with health insurance (47%), as illustrated in Fig. 2 [2]. Additionally, at least six in ten Black adults (60%) and Hispanic adults (65%) report difficulty affording healthcare costs compared to about four in ten White adults (39%) [2]. Adults in low-income households (annual income under $40 000) are more than three times as likely as those in high-income households (annual income over $90 000) to report difficulty affording healthcare costs (69% vs. 21%) [2].

Figure 2.

Figure 2.

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Healthcare cost among race in the USA[2].

Healthcare debt is a complex problem that must be effectively solved by addressing the underlying causes and providing relief for patients struggling with financial difficulties, as shown in Fig. 3 [2].

Figure 3.

Figure 3.

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Sources of healthcare debts in the USA[2].

This article seeks to critically evaluate the key factors contributing to healthcare debt in the United States, assess its impact on healthcare users, and propose actionable solutions.

Method

To comprehend the drivers of this crisis, an extensive literature search was conducted in multiple databases (Scopus, PubMed, MEDLINE, EMBASE, Cochrane Library) to identify relevant studies on healthcare debts and their burden in the United States using relevant keywords, including “healthcare debt,” “United States health system,” “healthcare financial burden,” “medical debt,” “healthcare costs,” “health expenditure,” and “out-of-pocket expenses.” Data from the databases for the selected keywords were extracted and analyzed using a narrative synthesis approach to provide a concise overview of the evidence. References were also manually searched to ensure inclusiveness.

Search strategy: A comprehensive search of electronic databases (Scopus, PubMed, MEDLINE, EMBASE, Cochrane Library, etc.) for relevant articles published between 2000 and 2024 And 140 articles, and reports were screened.

Inclusion criteria: Studies focusing on healthcare debts in the United States, including quantitative, qualitative, review, and mixed-methods research. Out of 140 papers and reports screened, 60 were included

Exclusion criteria: Studies outside the specified time frame or those not relevant to the scope of healthcare debts. Out of 140 papers and reports screened, 80 articles and reports were screened out.

Results and discussions

The increasing costs of medical services, including expensive medications and advanced technologies, are a major driver of the overwhelming financial burden in the healthcare crisis in the United States [3]. A lack of pricing transparency and inadequate insurance coverage further contribute to the accumulation of debt, especially for those who are uninsured or underinsured. The fragmented nature of the healthcare system worsens the problem by leading to duplicated services, inefficient resource use, and increased administrative expenses. Healthcare debt negatively impacts both physical and mental health, often resulting in heightened stress, anxiety, and depression. Unpaid medical bills cause individuals to avoid necessary care, increasing health conditions and straining the healthcare system. Additionally, this debt can damage credit scores, limit access to financial services, and hinder employment opportunities.

Healthcare debt in the United States places a heavy financial burden on many individuals and families, and the United States has one of the highest healthcare costs in the world, and even with insurance, out-of-pocket expenses for medical services, prescription drugs, and premiums can be overwhelming [3,4]. While many Americans have health insurance, it often doesn’t cover everything. High deductibles, copayments, and coinsurance can leave individuals responsible for a significant portion of their medical bills. Healthcare debt is one of the leading causes of personal bankruptcy in the United States [4]. Even those with insurance can face financial ruin when medical costs exceed their coverage. Despite the Affordable Care Act (ACA), many people remain uninsured due to high premiums, limited coverage options, and eligibility restrictions[5]. Unpaid medical bills often lead to aggressive debt collection tactics, such as lawsuits, salary deduction, and damage to credit scores, worsening financial stress for those already struggling with healthcare debt[6]. These burdens disproportionately affect low-income individuals and minority communities, who often face limited access to affordable healthcare and systemic inequities that make managing healthcare costs even more difficult.

Many policy ideas have been suggested to address rising healthcare costs and reduce healthcare debts, these include expanding insurance coverage, lowering prescription drug prices, and reforming the healthcare system[7]. Additionally, non-profit organizations and charities offer programs to help people manage their medical bills. These programs may provide financial assistance or help patients negotiate reduced payment plans with healthcare providers. Healthcare debt is a complicated and pressing issue in the United States, requiring well-rounded solutions that focus on both making care more affordable and improving access to health insurance.

A critical appraisal of drivers of healthcare debts in the United States

Healthcare debt has become a serious challenge in the United States, as many individuals and families are struggling with overwhelming medical bills. This growing crisis has several causes, all of which contribute to the rise in healthcare debt. One of the main reasons behind healthcare debt is the extremely high cost of medical services in the United States, which are among the most expensive in the world. Many Americans find it difficult to cover these costs, with about 6% of adults owing more than $1,000 in medical debt[8]. Rising drug prices, advanced medical technologies, and complicated administrative systems only add to the financial burden on patients. Since the United States does not have universal healthcare, individuals are often left to cover large out-of-pocket expenses, including for prescription medications. About 25% of Americans struggle to afford their medications due to these high costs. Pharmaceutical companies argue that the high prices are necessary to support innovation, but this leaves many patients facing difficult choices[9].

Millions of Americans face financial struggles due to the way healthcare is funded in the United States, often leading to debt and the loss of assets. In 2015, a large number of people under 65 reported difficulties paying medical bills, with more than half of them owing over $2,500[10]. A big part of this problem comes from inadequate or no health insurance, which leaves many people vulnerable to financial trouble. The lack of universal health coverage has made the healthcare debt crisis worse. In 2021, as the COVID-19 pandemic continued, 27 million Americans, or 8.3% of the population, were still without health insurance[11]. Even people with insurance often face high deductibles, co-payments, and gaps in coverage, which result in significant out-of-pocket costs. This leaves many at risk of accumulating medical debt. In fact, about one-third of insured individuals worry about being able to afford their monthly premiums[12]. Healthcare debt can also prevent people from getting the care they need, worsening both their physical and mental health. Some organizations are working to ease this burden by providing support within the healthcare system, but many Americans still struggle under the weight of medical debt as illustrated in Fig. 4[13].

Figure 4.

Figure 4.

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Chart showing the organizational structure of the healthcare system in the United States[13].

Underinsurance is a major factor worsening the healthcare debt crisis in the United States[14]. Even those with health insurance often face gaps in coverage or high out-of-pocket costs, deductibles, co-payments, and coinsurance can be prohibitively expensive, making it difficult for many people to afford necessary medical care and leading to the accumulation of medical debt[14]. The fragmented US healthcare system also contributes to rising debt. The system’s inadequate coordination and continuity of care increases costs and inefficiency. A report highlighted that the US health insurance system is “highly fragmented,” with high administrative spending and little effort to control healthcare costs in the private insurance market[15]. This fragmentation leads to the unnecessary duplication of services, inefficient use of resources, and higher administrative expenses. As a result, patients often receive uncoordinated care, which can be both costly and ineffective. Medical emergencies are another significant cause of healthcare debt[15], unexpected health crises, such as accidents, sudden illnesses, or chronic conditions, can result in substantial medical expenses that many people cannot afford, without adequate insurance coverage or financial resources, individuals and families are at high risk of falling into debt due to these unforeseen medical costs.

Socioeconomic disparities, such as income inequality and poverty, are major contributors to the healthcare debt crisis in the United States [16]. Low-income individuals, minority groups, and rural communities are disproportionately affected, as they face greater financial barriers to accessing care, while compared to other high-income countries, these groups in the United States experience more severe challenges in affording healthcare, especially those without insurance[16,17]. As a result, many are forced to rely on more expensive emergency care or delay treatment, which leads to higher medical costs and deeper debt. This creates a cycle of debt and economic instability, particularly for the most vulnerable populations.

Medical bankruptcy is another widespread issue, where overwhelming medical debt forces people into financial struggles[17]. Even those with health insurance can face crippling costs due to high deductibles, co-payments, or out-of-network charges, while this not only affects individuals but also puts additional strain on the overall healthcare system. Regular medical needs, such as doctor visits and diagnostic tests, are common contributors to healthcare debt. More than half of those with healthcare debt report that routine doctor visits were a factor, while about 60% cite lab fees or diagnostic tests[18]. Additionally, many adults point to emergency care fees as the source of their debt from one-time medical crises. The healthcare debt crisis in the United States is shaped by a complex mix of high medical costs, insufficient insurance coverage, unexpected emergencies, and socioeconomic inequality, therefore, understanding these factors is key to finding effective solutions that can ease the financial burden on individuals and families.

Burden of healthcare debts in the United States

Healthcare debt is an unexpected and overwhelming burden that millions of Americans face. It can drain finances and take an emotional toll, causing feelings of anger, depression, fear, and frustration for those struggling with it[19]. The impact of healthcare debt varies from person to person, depending on factors like race, income, and age. It tends to hit Black and Hispanic Americans, low-income earners, and young adults the hardest[19]. Unpaid medical bills lead to various problems, including difficulty accessing necessary healthcare services, damaged credit scores, and worsening physical, mental, and emotional health, while these issues can be made worse by aggressive debt collection methods used by creditors.

Healthcare debt doesn’t just affect individuals, it has broader consequences for the government and the healthcare system. It contributes to economic instability and lower productivity[19]. People with healthcare debt often avoid or delay necessary medical care, leading to poorer health outcomes (Fig. 5). Financial problems, such as bankruptcy and reduced access to credit, are common consequences. Ultimately, healthcare debt creates a cycle of hardship that impacts both personal well-being and society as a whole.

Figure 5.

Figure 5.

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Adults with the medical or dental bill; source: KFF healthcare debt survey[2].

Physical and mental health

Healthcare debt is a major factor in worsening the health of many Americans, especially those with low to middle incomes[20]. Unpaid medical bills have been linked to both physical and mental health issues, while studies show that 2 out of 5 Americans are emotionally affected by medical debt more than other serious illnesses[20,21]. Experts now see medical debt as a key social factor that impacts mental and physical well-being[22]. People with medical debt often face health problems like high blood pressure, poor mental health, a shorter life expectancy, and lower overall health, and this will not only puts more strain on the healthcare system but also weakens the country’s economy by contributing to higher illness rates[23]. Unfortunately, the poor health that results from medical debt often leads to more debt, creating a vicious cycle. Medical debt doesn’t just cause new health issues, it also worsens existing health conditions, increases health disparities, and negatively affects health outcomes[24]. The combination of these factors leads to economic instability, mental health challenges, and greater inequality in accessing medical care, all of which weaken the social fabric of communities.

The stress that comes from accumulating healthcare debt can lead to dangerous health behaviours, such as drinking more alcohol, eating poorly, and even smoking[25]. This stress often arises from the constant fear of legal action and threats from debt collectors, which can feel overwhelming[26]. Additionally, burdens like wage reduction, home foreclosures, and property liens add to the anxiety that affects overall health. While it’s clear that poor health contributes to healthcare debt, the opposite is also true medical debt can worsen existing health disparities[27]. Research shows that healthcare debts can lead to negative physical, social, and emotional health outcomes, and may even increase the risk of suicidal thoughts[27,28]. Ongoing stress from unpaid medical bills is linked to declining physical health, and having high unsecured debt, such as medical debt, can significantly disrupt daily life. Moreover, studies have found that people with high levels of debt, including healthcare debt, are at a greater risk of dying earlier[28-30]. Mental health issues among those with medical debt are also increasing, with anxiety, depression, and stress reported to be three times more common in individuals with unpaid medical bills[30].

Therefore, healthcare debt has profound effects on mental health, leading to increased anxiety, depression, and stress, and the constant worry about unpaid medical bills can create a persistent state of fear and uncertainty, significantly affecting individuals’ emotional well-being. As a result, healthcare debt is not just a financial issue; it is a critical social determinant of mental health that requires urgent attention and comprehensive solutions to mitigate its impact on individuals and communities, and addressing healthcare debt can play a vital role in improving overall mental health outcomes and fostering a healthier society.

Trade-offs, financial health, and bankruptcy

Healthcare debt creates significant financial stress for those burdened by it, leading to serious consequences for their overall well-being. Many working-class Americans find themselves struggling under the weight of healthcare debts, making it a major contributor to their financial crises. While the uninsured often face the most severe challenges, even those with insurance are not immune to the high costs of medical bills and accumulating debt[31]. The effects of healthcare debt extend beyond just paying for medical services, while individuals grappling with these debts often have to make difficult choices about how to spend their money, which can impact their ability to save or invest in other important areas of their lives. When medical bills go unpaid, this result in even more financial hardships, such as reduced access to credit, a higher likelihood of bankruptcy, and potential legal actions that could lead to wage reduction or loss of personal property[32].

Bankruptcy is a significant concern for many who find themselves overwhelmed by healthcare debt. A large number of Americans filing for bankruptcy cite medical bills as a primary reason, often owing money to hospitals, healthcare providers, and credit card companies linked to healthcare expenses[33]. This situation can lead to a cycle of accumulating debt due to high interest rates and fees, further straining their financial health. Additionally, the emotional toll of bankruptcy can be heavy, while those affected may experience lasting impacts on their credit scores, which can limit their access to credit in the future and affect various aspects of their lives, including employment opportunities and housing[33]. The repercussions of healthcare debt extend far beyond financial concerns, influencing individuals’ mental health and overall quality of life for years to come.

Effects on credit history and scores

Unpaid medical bills can have a lasting impact on a person’s financial future by becoming part of their credit report[32,34]. When these debts are reported to credit bureaus, they affect the individual’s credit score, which is a key factor used by lenders to determine creditworthiness, and this negative information can linger for up to seven years, especially if the debt remains unpaid for more than 180 days[35]. A lower credit score can make it difficult for individuals to access credit for essential needs like housing, transportation, and building wealth. Lenders often rely on credit scores to assess whether someone is eligible for loans and their ability to repay them.

Unfortunately, a poor credit score can also influence job prospects, as employers may consider credit history during the hiring and promotion processes[36]. Moreover, those with lower credit scores often face higher interest rates on loans compared to individuals with better scores. This situation can create a cycle of debt, as they end up paying more for credit over time[37-39]. Additionally, a drop in credit score due to medical debt can complicate decisions about insurance, housing, mortgages, and car loans, ultimately leading to a future marked by ongoing financial challenges.

Avoidance or refusal of healthcare

Healthcare debts significantly impact individuals and communities when it comes to accessing necessary medical services. People burdened with existing medical debt are far less likely to seek out quality healthcare compared to those without such debts[39]. This reluctance often stems from the fear of accumulating more debt or a refusal to visit healthcare providers due to past unpaid bills[40-44]. In many cases, when multiple individuals in a community struggle with medical debt, it creates a financial strain on local healthcare providers, particularly in rural areas[45-48]. This collective burden can lead to the closure of hospitals and clinics, ultimately reducing access to essential medical care for everyone in the community. As a result, the entire population suffers from low healthcare resources, highlighting the far-reaching consequences of healthcare debt.

Many low-income individuals and those without adequate insurance often find themselves avoiding or delaying medical care due to unpaid medical bills[48]. This choice becomes a necessity as they try to steer clear of accumulating even more debt. Unfortunately, this can have dire consequences for their health some people with serious conditions like cancer are skipping necessary treatments out of fear of financial strain, and the stress of these financial considerations can lead to worsening health. For those already facing medical debt, accessing non-emergency care can feel almost impossible. They may even find themselves turned away by healthcare providers because of their outstanding bills. A 2019 family health survey revealed that half of those burdened by medical debt avoided seeking healthcare, and many families reported skipping recommended tests and treatments[49].

Medical debt often stems from unforeseen injuries or illnesses that no one can control, making it particularly harmful. It’s unfortunate that health issues, which lead to significant medical debt, are also the reason many people struggle to access quality care[50]. This avoidance of necessary healthcare not only weighs heavily on individuals but also negatively affects the overall health of the nation. Many people facing medical debt live below the poverty line, which ultimately hampers the economy. To recover unpaid bills, healthcare providers may require upfront payments or expect individuals to settle existing debts before receiving services[51]. In some cases, this can lead to cold and unwelcoming interactions that cause emotional distress for patients already under financial strain.

Debtors’ examinations and collection litigation

The rise of collection litigation by debt collectors presents a serious threat and significant burden for individuals with outstanding medical bills. Approximately 25% of high-income hospitals in the United States are known to sue patients who have contributed to their bankruptcies through unpaid medical debts[52]. Research indicates that many debtors often do not respond to these lawsuits, leading to default judgments against them[53]. This can result in severe consequences such as property seizures, wage reduction, and even jail time for those who fail to appear in court for debtor examinations [54]. While it is unconstitutional to jail individuals solely for their inability to pay debts, failing to attend court hearings or provide required financial documentation can lead to legal penalties, including imprisonment[55]. Unfortunately, one of the alarming effects of medical debt today is homelessness, often resulting from property seizures initiated by creditors. When a default judgment is entered, creditors may seize assets like homes, vehicles, and bank account balances. For instance, between 2017 and 2018, nearly 4,880 homes of medical debtors were seized by 56 non-profit hospitals in New York[51]. Wage reduction is another common issue faced by those in medical debt. This process involves creditors withdrawing a portion of a debtor’s paycheck before the individual even receives their wages. Such actions typically occur when creditors seek a court order for repayment, allowing for deductions of up to 25% from the debtor’s salary[52]. Many of these households live below the poverty line, further impacting their emotional and social well-being.

Recommendations

To effectively address the issue of healthcare debts in the United States, several detailed and actionable recommendations can be implemented. First, expanding access to affordable healthcare is crucial; this could involve implementing sliding scale fees at healthcare facilities based on income and increasing enrolment efforts for public programs like Medicaid and CHIP[56]. Additionally, establishing a medical debt forgiveness program would provide much-needed relief for low-income patients, perhaps funded through partnerships with non-profit organizations that specialize in debt relief. So, strengthening consumer protections is also essential, including enforcing fair billing practices to ensure transparency and limiting aggressive debt collection methods that unfairly target vulnerable populations.

Therefore, enhancing financial literacy through community-based educational programs can empower individuals to better manage healthcare costs and navigate medical billing processes, while offering financial counselling services at hospitals can provide tailored support for those struggling with medical expenses. Furthermore, improving health insurance coverage is vital, advocating for universal coverage to reduce the number of uninsured individuals and enhancing insurance benefits to lower out-of-pocket costs. Implementing community-based healthcare initiatives, such as mobile clinics and partnerships with local organizations, can bring essential services to underserved areas, preventing the accumulation of medical debt[57]. Also, leveraging technology through mobile apps that track medical expenses and promote telehealth services can also make healthcare more accessible and affordable.

Overall, encouraging employers to adopt comprehensive health programs, including financial assistance for unexpected medical costs, can significantly alleviate the burden on employees[58]. Finally, engaging in advocacy for healthcare policy reform and supporting research on healthcare costs can help drive systemic changes that address the root causes of medical debt[59]. By implementing these recommendations collaboratively, stakeholders can make substantial progress in reducing the burden of healthcare debt, ultimately improving the health and financial well-being of individuals and families across the nation.

Conclusion

Healthcare debt has become a widespread problem in the United States, impacting millions of families and individuals. This financial strain is especially hard on low- to middle-income earners, who often struggle to keep up with the high costs of medical care. Even those with insurance can find themselves facing hefty out-of-pocket expenses, leading to significant stress and financial difficulties. For uninsured or underinsured individuals, the situation is even more dire, as they may avoid necessary medical care altogether. This avoidance can lead to worse health outcomes and mounting debt. Clearly, there is a pressing need for meaningful reforms in our healthcare system to relieve the financial burdens associated with medical expenses.

The effects of healthcare debt extend well beyond finances; they can profoundly impact mental and physical health as well. Many people burdened by medical debt experience increased levels of stress, anxiety, and depression, which can worsen existing health issues and create new ones. This creates a vicious cycle: deteriorating health leads to higher medical costs, trapping individuals in a never-ending loop of debt and poor health. Moreover, the stigma surrounding debt can result in feelings of shame and isolation, making the mental health challenges even more difficult to navigate. This connection between healthcare debt and mental well-being emphasizes the need for integrated support services that address both financial and health concerns.

On a broader scale, healthcare debt presents significant challenges for our economy and healthcare system as a whole. The build-up of unpaid medical bills can destabilize healthcare providers, particularly in rural areas where resources are already scarce. When hospitals and clinics struggle to recover costs from unpaid debts, they may have to cut services, lay off staff, or even shut down. This situation creates a domino effect, limiting access to vital healthcare services for entire communities and deepening health disparities and economic inequality. Policymakers must recognize the economic consequences of healthcare debt and take steps to implement solutions that protect both patients and healthcare providers. To tackle healthcare debt effectively, a multi-faceted approach is essential. This includes implementing policy changes, boosting financial literacy, and improving access to affordable care. Expanding Medicaid and promoting financial assistance programs can help lighten the load for low-income individuals. Moreover, increasing transparency in medical billing can empower patients to make informed decisions about their healthcare. By educating individuals on how to navigate the healthcare system and manage medical costs, we can help them seek the care they need without the fear of falling into crippling debt.

In summary, healthcare debt is a critical issue that affects millions of Americans and poses serious challenges to individual health and economic stability, as well as the healthcare system overall. Tackling this complex problem requires collaboration between healthcare providers, policymakers, and community organizations to develop effective solutions that ensure financial security and equitable access to care. By prioritizing reforms that lower healthcare costs, enhance financial assistance programs, and promote consumer education, we can work toward a future where healthcare is a right for all, not a financial burden.

Acknowledgements

None.

Footnotes

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 21 January 2025

Contributor Information

Abdullahi Tunde Aborode, Email: abdullahiaborodet@gmail.com.

Oreoluwa Oginni, Email: oginnioreoluwagabriel@gmail.com.

Ottoho Edima, Email: edimaottoho@gmail.com.

Emily Lamunu, Email: elamunu@bu.edu.

Tayo Nafisat Folorunso, Email: temitayofolorunso4@gmail.com.

Christian Inya Oko, Email: christianinyaoko@gmail.com.

Akinjo Rebecca Iretiayo, Email: akinjo.rebecca2@gmail.com.

Lukman Lawal, Email: lawallukman90@gmail.com.

Ruth Amarachi, Email: Marachi75@gmail.com.

Rawa Badri, Email: Badri@gmail.com.

Gafar Babatunde Bamigbade, Email: 202190058@uaeu.ac.ae.

Omotayo Faith Olanrewaju, Email: omotayofaith0@gmail.com.

Favour Obianuju Agwuna, Email: favour.agwuna.241420@unn.edu.ng.

Ridwan Olamilekan Adesola, Email: adesolaridwanolamilekan@gmail.com.

Ethical approval

No ethical approval is needed for this study.

Consent

Not applicable.

Sources of funding

No funding is available.

Author’s contributions

All the authors contributed equally to data collection, critically reviewed the content, and significantly contributed to the writing of the manuscript. All authors read and approved the final manuscript.

Conflicts of interest disclosure

The authors reported no potential conflict of interest.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Dr Abdullahi Tunde Aborode.

Provenance and peer review

Not commissioned, externally peer-reviewed.

Data availability statement

Not available.

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