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Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction

View Article: PubMed Central - PubMed

ABSTRACT

Background: Financial barriers to health care are associated with worse outcomes following acute myocardial infarction (AMI). Yet, it is unknown whether the prevalence of financial barriers and their relationship with post‐AMI outcomes vary by sex among young adults.

Methods and results: We assessed sex differences in patient‐reported financial barriers among adults aged <55 years with AMI using data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study. We examined the prevalence of financial barriers and their association with health status 12 months post‐AMI. Among 3437 patients, more women than men reported financial barriers to medications (22.3% vs 17.2%; P=0.001), but rates of financial barriers to services were similar (31.3% vs 28.9%; P=0.152). In multivariable linear regression models adjusting for baseline health, psychosocial status, and clinical characteristics, compared with no financial barriers, women and men with financial barriers to services and medications had worse mental functional status (Short Form‐12 mental health score: mean difference [MD]=−3.28 and −3.35, respectively), greater depressive symptomatology (Patient Health Questionnaire‐9: MD, 2.18 and 2.16), lower quality of life (Seattle Angina Questionnaire–Quality of Life: MD, −4.98 and −7.66), and higher perceived stress (Perceived Stress Score: MD, 3.76 and 3.90; all P<0.05). There was no interaction between sex and financial barriers.

Conclusions: Financial barriers to care are common in young patients with AMI and associated with worse health outcomes 1 year post‐AMI. Whereas women experienced more financial barriers than men, the association did not vary by sex. These findings emphasize the importance of addressing financial barriers to recovery post‐AMI in young adults.

No MeSH data available.


Related in: MedlinePlus

Adjusted mean differences in 12‐month outcomes between patients with and without financial barriers in women*. Adjusted mean health status, quality of life, depression, and stress score differences at 12 months post‐AMI in patients with no financial barriers (light blue), financial barriers to services only (dark blue), financial barriers to medications only (red), and financial barriers to services and medications (green). These values represent adjusted differences between baseline and 12‐month scores. Adjusted for demographic (age, sex, race, marital status, live alone, education, and employment), risk factors and comorbidities (diabetes mellitus, hypertension, smoking, past MI, COPD, heart failure, past stroke, depression [except in the PHQ‐9 model], low social support, alcohol abuse, and BMI groups), clinical presentation (STEMI, GRACE score, renal dysfunction, and time to presentation), and inpatient care (reperfusion therapy). AMI indicates acute myocardial infarction; BMI, body mass index; COPD, chronic obstructive pulmonary disorder; GRACE, Global Registry of Acute Coronary Event; MCS, Mental Component Summary; MI, myocardial infarction; PCS, Physical Component Summary; PHQ‐9, Patient Health Questionnaire; PSS, Perceived Stress Scale; SAQ‐QoL, Seattle Angina Questionnaire–Quality of Life; SF‐12, 12‐Item Short‐Form; STEMI, ST‐elevation myocardial infarction. *Reference category is “no financial barriers” group.
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jah31752-fig-0003: Adjusted mean differences in 12‐month outcomes between patients with and without financial barriers in women*. Adjusted mean health status, quality of life, depression, and stress score differences at 12 months post‐AMI in patients with no financial barriers (light blue), financial barriers to services only (dark blue), financial barriers to medications only (red), and financial barriers to services and medications (green). These values represent adjusted differences between baseline and 12‐month scores. Adjusted for demographic (age, sex, race, marital status, live alone, education, and employment), risk factors and comorbidities (diabetes mellitus, hypertension, smoking, past MI, COPD, heart failure, past stroke, depression [except in the PHQ‐9 model], low social support, alcohol abuse, and BMI groups), clinical presentation (STEMI, GRACE score, renal dysfunction, and time to presentation), and inpatient care (reperfusion therapy). AMI indicates acute myocardial infarction; BMI, body mass index; COPD, chronic obstructive pulmonary disorder; GRACE, Global Registry of Acute Coronary Event; MCS, Mental Component Summary; MI, myocardial infarction; PCS, Physical Component Summary; PHQ‐9, Patient Health Questionnaire; PSS, Perceived Stress Scale; SAQ‐QoL, Seattle Angina Questionnaire–Quality of Life; SF‐12, 12‐Item Short‐Form; STEMI, ST‐elevation myocardial infarction. *Reference category is “no financial barriers” group.

Mentions: These associations remained similar after adjustment for baseline health and psychosocial status as well as demographic and clinical characteristics. After adjustment, in comparison to patients without financial barriers, women and men with financial barriers to both services and medications reported lower mental functional status (SF‐12 MCS: women, β −3.28, SE 0.73, P<0.001; men, β −3.35, SE 1.10, P=0.003), greater depressive symptomatology (PHQ‐9: women, β 2.18, SE 0.34, P<0.001; men, β 2.16, SE 0.54, P<0.001), lower quality of life (SAQ‐QoL: women, β −4.98, SE 1.50, P=0.001; men, β −7.66, SE 2.39, P=0.002), and higher perceived stress (PSS: women, β 3.76, SE ,0.61, P<0.001; men, β 3.90, SE 0.94, P<0.001; Figures 3 and 4). Women with financial barriers to both services and medications also reported lower physical status at 12 months (SF‐12 PCS: β −2.68, SE 0.66, P<0.001) than women without financial barriers. No interactions between sex and financial barriers were observed in any of the fully adjusted models (all P>0.1; Table 5). Analyses performed with missing data imputed show nearly identical results for all health outcomes.


Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction
Adjusted mean differences in 12‐month outcomes between patients with and without financial barriers in women*. Adjusted mean health status, quality of life, depression, and stress score differences at 12 months post‐AMI in patients with no financial barriers (light blue), financial barriers to services only (dark blue), financial barriers to medications only (red), and financial barriers to services and medications (green). These values represent adjusted differences between baseline and 12‐month scores. Adjusted for demographic (age, sex, race, marital status, live alone, education, and employment), risk factors and comorbidities (diabetes mellitus, hypertension, smoking, past MI, COPD, heart failure, past stroke, depression [except in the PHQ‐9 model], low social support, alcohol abuse, and BMI groups), clinical presentation (STEMI, GRACE score, renal dysfunction, and time to presentation), and inpatient care (reperfusion therapy). AMI indicates acute myocardial infarction; BMI, body mass index; COPD, chronic obstructive pulmonary disorder; GRACE, Global Registry of Acute Coronary Event; MCS, Mental Component Summary; MI, myocardial infarction; PCS, Physical Component Summary; PHQ‐9, Patient Health Questionnaire; PSS, Perceived Stress Scale; SAQ‐QoL, Seattle Angina Questionnaire–Quality of Life; SF‐12, 12‐Item Short‐Form; STEMI, ST‐elevation myocardial infarction. *Reference category is “no financial barriers” group.
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Show All Figures
getmorefigures.php?uid=PMC5121496&req=5

jah31752-fig-0003: Adjusted mean differences in 12‐month outcomes between patients with and without financial barriers in women*. Adjusted mean health status, quality of life, depression, and stress score differences at 12 months post‐AMI in patients with no financial barriers (light blue), financial barriers to services only (dark blue), financial barriers to medications only (red), and financial barriers to services and medications (green). These values represent adjusted differences between baseline and 12‐month scores. Adjusted for demographic (age, sex, race, marital status, live alone, education, and employment), risk factors and comorbidities (diabetes mellitus, hypertension, smoking, past MI, COPD, heart failure, past stroke, depression [except in the PHQ‐9 model], low social support, alcohol abuse, and BMI groups), clinical presentation (STEMI, GRACE score, renal dysfunction, and time to presentation), and inpatient care (reperfusion therapy). AMI indicates acute myocardial infarction; BMI, body mass index; COPD, chronic obstructive pulmonary disorder; GRACE, Global Registry of Acute Coronary Event; MCS, Mental Component Summary; MI, myocardial infarction; PCS, Physical Component Summary; PHQ‐9, Patient Health Questionnaire; PSS, Perceived Stress Scale; SAQ‐QoL, Seattle Angina Questionnaire–Quality of Life; SF‐12, 12‐Item Short‐Form; STEMI, ST‐elevation myocardial infarction. *Reference category is “no financial barriers” group.
Mentions: These associations remained similar after adjustment for baseline health and psychosocial status as well as demographic and clinical characteristics. After adjustment, in comparison to patients without financial barriers, women and men with financial barriers to both services and medications reported lower mental functional status (SF‐12 MCS: women, β −3.28, SE 0.73, P<0.001; men, β −3.35, SE 1.10, P=0.003), greater depressive symptomatology (PHQ‐9: women, β 2.18, SE 0.34, P<0.001; men, β 2.16, SE 0.54, P<0.001), lower quality of life (SAQ‐QoL: women, β −4.98, SE 1.50, P=0.001; men, β −7.66, SE 2.39, P=0.002), and higher perceived stress (PSS: women, β 3.76, SE ,0.61, P<0.001; men, β 3.90, SE 0.94, P<0.001; Figures 3 and 4). Women with financial barriers to both services and medications also reported lower physical status at 12 months (SF‐12 PCS: β −2.68, SE 0.66, P<0.001) than women without financial barriers. No interactions between sex and financial barriers were observed in any of the fully adjusted models (all P>0.1; Table 5). Analyses performed with missing data imputed show nearly identical results for all health outcomes.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Financial barriers to health care are associated with worse outcomes following acute myocardial infarction (AMI). Yet, it is unknown whether the prevalence of financial barriers and their relationship with post&#8208;AMI outcomes vary by sex among young adults.

Methods and results: We assessed sex differences in patient&#8208;reported financial barriers among adults aged &lt;55&nbsp;years with AMI using data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study. We examined the prevalence of financial barriers and their association with health status 12 months post&#8208;AMI. Among 3437 patients, more women than men reported financial barriers to medications (22.3% vs 17.2%; P=0.001), but rates of financial barriers to services were similar (31.3% vs 28.9%; P=0.152). In multivariable linear regression models adjusting for baseline health, psychosocial status, and clinical characteristics, compared with no financial barriers, women and men with financial barriers to services and medications had worse mental functional status (Short Form&#8208;12 mental health score: mean difference [MD]=&minus;3.28 and &minus;3.35, respectively), greater depressive symptomatology (Patient Health Questionnaire&#8208;9: MD, 2.18 and 2.16), lower quality of life (Seattle Angina Questionnaire&ndash;Quality of Life: MD, &minus;4.98 and &minus;7.66), and higher perceived stress (Perceived Stress Score: MD, 3.76 and 3.90; all P&lt;0.05). There was no interaction between sex and financial barriers.

Conclusions: Financial barriers to care are common in young patients with AMI and associated with worse health outcomes 1&nbsp;year post&#8208;AMI. Whereas women experienced more financial barriers than men, the association did not vary by sex. These findings emphasize the importance of addressing financial barriers to recovery post&#8208;AMI in young adults.

No MeSH data available.


Related in: MedlinePlus