Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction

Abstract

This prospective study assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for US patients with acute myocardial infarction (AMI). We also assessed gender differences in such prehospital delay for AMI in Spain, a country with universal insurance. We used data from 2,951 US and 496 Spanish patients aged 18–55 years with AMI. US patients were grouped by insurance status: adequately insured, underinsured, or uninsured. For each country, we assessed the association between gender and prehospital delay (symptom onset to hospital arrival). For the US cohort, we modeled the relationship between insurance groups and delay of >12 hours. US women were less likely than men to be uninsured, but more likely to be underinsured and a larger proportion of women than men experienced delays of >12 hours (38% versus 29%). We found no association between insurance status and delays of >12 hours in men or women. Only 17.3% of Spanish patients had delays of >12 hours and there were no significant gender differences. In conclusion, women were more likely than men to delay, though it was not explained by differences in insurance status. The lack of gender differences in prehospital delays in Spain suggests that these differences may vary by health care system and culture.

Prehospital Delay in Older Adults with Acute Myocardial Infarction: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction Study

“…Twelve potential explanatory variables were selected a priori from the following domains: demographic characteristics, clinical presentation, comorbid conditions, prehospital disability, and social support. Older age, female sex, nonwhite race, heart failure (HF), diabetes mellitus, and atypical symptoms were selected on the basis of prior literature suggesting associations with delay in younger cohorts . Variables that we hypothesized could plausibly be associated with delay based on our experiences in clinical medicine were also included in the multivariable model.…”

“…Female sex, diabetes mellitus, and nonwhite race, were associated most consistently with prehospital delay. These studies largely included a broad age spectrum without distinctly examining older adults or were restricted to younger populations . This is problematic because older adults may face different challenges in timeliness of their response to symptoms than younger individuals, including limitations in social support or mobility.…”

Young Women With Acute Myocardial Infarction

“…Medicare, Medicaid) as compared with private insurance. 39, 41 Compared with men, women also are more likely than men to have a primary care provider, and as likely as men to have a specialist involved in their care. 32 …”

“…32, 33 Moreover, they report both a higher rate of lifetime history of depression and depressive symptoms as well as poorer social supports, more anxiety and greater perceived stress at the time of an AMI. 19, 32, 34, 41, 43–45 …”

“…16, 32, 46 Potentially because women do not recognize these symptoms as being signs of AMI, young women are more likely than men to delay seeking care, frequently presenting after 6 hours of symptom onset. 32, 41, 46 …”