Barriers to Healthcare Access and Long-Term Survival After an Acute Coronary Syndrome

Erskine, Nathaniel; Waring, Molly E.; McManus, David D.; Lessard, Darleen M.; Kiefe, Catarina I.; Goldberg, Robert J.

doi:10.1007/s11606-018-4555-y

Cited by 15 publications

(9 citation statements)

References 41 publications

(40 reference statements)

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“…People with unmet medical needs due to cost or without a usual source of care experience higher health costs and worse health outcomes, [37][38][39][40][41][42] and our findings indicate that these barriers are disproportionately more prevalent among racial and ethnic minorities.…”

Section: Discussionmentioning

confidence: 63%

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Caraballo

Massey

Mahajan

et al. 2020

Preprint

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Importance: Racial and ethnic disparities plague the US health care system despite efforts to eliminate them. To understand what has been achieved amid these efforts, a comprehensive study from the population perspective is needed. Objectives: To determine trends in rates and racial/ethnic disparities of key access to care measures among adults in the US in the last two decades. Design: Cross-sectional. Setting: Data from the National Health Interview Survey, 1999-2018. Participants: Individuals >18 years old. Exposure: Race and ethnicity: non-Hispanic Black, non-Hispanic Asian, non-Hispanic White, Hispanic. Main outcome and measures: Rates of lack of insurance coverage, lack of a usual source of care, and foregone/delayed medical care due to cost. We also estimated the gap between non-Hispanic White and the other subgroups for these outcomes. Results: We included 596,355 adults, of which 69.7% identified as White, 11.8% as Black, 4.7% as Asian, and 13.8% as Hispanic. The proportion uninsured and the rates of lacking a usual source of care remained stable across all 4 race/ethnicity subgroups up to 2009, while rates of foregone/delayed medical care due to cost increased. Between 2010 and 2015, the percentage of uninsured diminished for all, with the steepest reduction among Hispanics (-2.1% per year). In the same period, rates of no usual source of care declined only among Hispanics (-1.2% per year) while rates of foregone/delayed medical care due to cost decreased for all. No substantial changes were observed from 2016-2018 in any outcome across subgroups. Compared with 1999, in 2018 the rates of foregone/delayed medical care due to cost were higher for all (+3.1% among Whites, +3.1% among Blacks, +0.5% among Asians, and +2.2% among Hispanics) without significant change in gaps; rates of no usual source of care were not significantly different among Whites or Blacks but were lower among Hispanics (-4.9%) and Asians (-6.4%). Conclusions and Relevance: Insurance coverage increased for all, but millions of individuals remained uninsured or underinsured with increasing rates of unmet medical needs due to cost. Those identifying as non-Hispanic Black and Hispanic continue to experience more barriers to health care services compared with non-Hispanic White individuals.

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Section: Discussionmentioning

confidence: 63%

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Caraballo

Massey

Mahajan

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…The authors found that patients who reported difficulty accessing healthcare due to transportation issues the year prior to MI had increased mortality at 2 -years post-MI. However, there were only 239 patients who reported transportation to be an issue with accessing medical care and the increased mortality among these patients appears to be due entirely to the 44 patients who reported having all three of the healthcare access barriers present: transportation barriers, financial barriers, and lack of usual source of medical care [25] .…”

Section: Discussionmentioning

confidence: 99%

Association between vehicle ownership and disparities in mortality after myocardial infarction

Goitia¹,

Onwuzurike²,

Chen³

et al. 2023

American Journal of Preventive Cardiology

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“…Importantly, we found that nearly 40% of the sample would need to drive for >1 hour to access PrEP. Studies have shown that transportation barriers have a significant impact on health outcomes, particularly among disadvantaged individuals [32,33]. Regarding HIV care and treatment, travel time has been found to be a barrier to retention in care [34,35].…”

Section: Discussionmentioning

confidence: 99%

Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey

Ojikutu¹,

Bogart²,

Mayer³

et al. 2019

JMIR Public Health Surveill

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Background Uptake of pre-exposure prophylaxis (PrEP) among black individuals in the United States is low and may be associated with the limited availability of clinics where PrEP is prescribed. Objective We aimed to determine the association between spatial access to clinics where PrEP is prescribed and willingness to use PrEP. Methods We identified locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents according to the ZIP code. Individual-level data were obtained from the 2016 National Survey on HIV in the Black Community. We used multilevel modelling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence) and ZIP code–level (%poverty, %unemployed, %uninsured, %black population, and density of health care facilities) variables. Results All participants identified as black/African American. Of the 787 participants, 45% were men and 23% were found to be at high risk based on the self-reported behavioral characteristics. The mean age of the participants was 34 years (SD 9), 54% of participants resided in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than 1 hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP (one SD higher density of PrEP clinics per 10,000 population was associated with 16% higher willingness [adjusted prevalence ratio=1.16, 95% CI: 1.03-1.31]). Conclusions Willingness to use PrEP was associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of black African Americans.

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Barriers to Healthcare Access and Long-Term Survival After an Acute Coronary Syndrome

Abstract: Absence of an established usual source of care and inconsistent transportation availability were associated with a higher risk for dying after an ACS. Patients with these barriers to follow-up care may benefit from more intensive follow-up and support.

Cited by 15 publications

References 41 publications

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

Association between vehicle ownership and disparities in mortality after myocardial infarction

Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey

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