While they are not the only measure of indebtedness, the percentage of adults with debt in collections and the median amount of such debts are good measures of the degree to which people struggle to pay what they owe.

The Urban Institute considers debt in collections “to include debt accounts (e.g., credit cards) that were previously more than 180 days past due and have been closed and charged off,” as well as unpaid student and car loans, medical and utility bills, parking tickets, child support payments, and membership fees that have been referred to a credit bureau.

Medical debt can be particularly debilitating. Credit Karma, for instance, reports that its members’ medical debt spiked by $2.8 billion between the end of May 2020 and the end of March 2021. The number of people who had medical debt that was past due increased to 21.4 million from 19.6 million. (Click here to see how many people in your state are burdened with medical debt.)

Click here to see the counties where people are struggling the most in debt.

To identify the counties where most people have debt in collections, 24/7 Wall St. reviewed data from the “Debt in America 2021” report, based on credit bureau information from 2020, published by the non-profit think tank the Urban Institute.   

Overall, according to the Urban Institute, more than 70 million Americans have debt in collections, and certain parts of the country are more affected than others. Of the 50 U.S. counties with the highest percentage of adults facing debt collectors, 22 are in Texas — and in one Texas county, nearly 70% have debt in collections. (Here are 16 counties where poverty is worse than you might think.)