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. 2022 Mar 1;7(3):341-345.
doi: 10.1001/jamacardio.2021.5430.

Evaluation of Factors Underlying Sex-Based Disparities in Cardiovascular Care in Adults With Self-reported Premature Atherosclerotic Cardiovascular Disease

Vardhmaan Jain  1 , Mahmoud Al Rifai  2 , Rodman Turpin  3 , Hatice Nur Eken  4 , Ankit Agrawal  1 , Dhruv Mahtta  2 , Zainab Samad  5 , Stephanie Coulter  6 , Fatima Rodriguez  7 , Laura A Petersen  8   9 , Salim S Virani  2   9   10
Affiliations

Evaluation of Factors Underlying Sex-Based Disparities in Cardiovascular Care in Adults With Self-reported Premature Atherosclerotic Cardiovascular Disease

Vardhmaan Jain et al. JAMA Cardiol. .

Abstract

Importance: There are limited data regarding sex-based differences in physical and mental health domains and health care access in adults with premature atherosclerotic cardiovascular disease (ASCVD).

Objective: To study the association of sex with physical and mental health domains as well as health care access-related factors among adults with self-reported premature ASCVD.

Design, setting, and participants: Retrospective cohort analysis of 748 090 adults aged 18 to 55 years in the Behavioral Risk Factor Surveillance System 2016 to 2019 in the US. Data were analyzed from June to July 2021.

Exposures: Self-reported ASCVD, defined as having a history of coronary artery disease, myocardial infarction, or stroke.

Main outcomes and measures: Self-reported physical and mental health and measures of health care access, including self-reported cost-related medication nonadherence and inability to see a physician due to cost.

Results: Between 2016 and 2019, 748 090 adults aged 18-55 years were identified, of whom 28 522 (3.3%) had self-reported premature ASCVD. Of these, 14 358 (47.0%) were women. Compared with men, women with premature ASCVD were more likely to report being clinically depressed (odds ratio [OR], 1.73; 95% CI, 1.41-2.14; P < .001), have cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11-1.82; P = .005), have not seen a physician due to cost-related issues (OR, 4.52; 95% CI, 2.24-9.13; P < .001), and were more likely to report overall poor physical health (OR, 1.39; 95% CI, 1.09-1.78; P = .008) despite being more likely to have health care coverage (85.3% vs 80.8%; P = .04) and a primary care physician (84.2% vs 75.7%; P < .001).

Conclusions and relevance: Results from this study indicate that women with premature ASCVD were more likely to report worse overall physical and mental health, inability to see a physician due to cost, and cost-related medical nonadherence. Interventions addressing mental health and out-of-pocket costs are needed in adults with premature ASCVD.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Turpin was supported by the University of Maryland Prevention Research Center cooperative agreement from the Centers for Disease Control and Prevention. Dr Rodriguez was funded by a career development award from the National Heart, Lung, and Blood Institute and the American Heart Association/Robert Wood Johnson Harold Amos Medical Faculty Development Program. Dr Virani reported grants from the US Department of Veterans Affairs, World Heart Federation, Tahir, and Jooma Family Research Grant during the conduct of the study and other support from the American College of Cardiology Honorarium in his role as the Associate Editor for Innovations ACC.org outside the submitted work. No other disclosures were reported.

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References

    1. Mahtta D, Khalid U, Misra A, Samad Z, Nasir K, Virani SS. Premature atherosclerotic cardiovascular disease: what have we learned recently? Curr Atheroscler Rep. 2020;22(9):44. doi:10.1007/s11883-020-00862-8 - DOI - PubMed
    1. Arora S, Stouffer GA, Kucharska-Newton AM, et al. . Twenty year trends and sex differences in young adults hospitalized with acute myocardial infarction. Circulation. 2019;139(8):1047-1056. doi:10.1161/CIRCULATIONAHA.118.037137 - DOI - PMC - PubMed
    1. Lee MT, Mahtta D, Ramsey DJ, et al. . Sex-related disparities in cardiovascular health care among patients with premature atherosclerotic cardiovascular disease. JAMA Cardiol. 2021;6(7):782-790. doi:10.1001/jamacardio.2021.0683 - DOI - PMC - PubMed
    1. Vikulova DN, Grubisic M, Zhao Y, et al. . Premature atherosclerotic cardiovascular disease: trends in incidence, risk factors, and sex-related differences, 2000 to 2016. J Am Heart Assoc. 2019;8(14):e012178. doi:10.1161/JAHA.119.012178 - DOI - PMC - PubMed
    1. Okunrintemi V, Valero-Elizondo J, Michos ED, et al. . Association of depression risk with patient experience, healthcare expenditure, and health resource utilization among adults with atherosclerotic cardiovascular disease. J Gen Intern Med. 2019;34(11):2427-2434. doi:10.1007/s11606-019-05325-8 - DOI - PMC - PubMed

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