Younger Stroke Survivors Have Reduced Access to Physician Care and Medications

Abstract

Background: More than 5 million US stroke survivors require comprehensive care for risk factor modification and secondary prevention. Younger stroke survivors may have reduced access to physician care and medications because they are more frequently uninsured. Objective: To assess age-related differences in access to physician care and medications among stroke survivors (aged 45-64 years vs Ն65 years).

Forecasting the Future of Stroke in the United States

“…Those aged 45 to 64 years represent 1.3 million of the estimated 4.1 million stroke survivors, but they report poorer access to physician care and lower medication affordability than older stroke survivors. 33 Lack of health insurance explains some of the reduced access to physician care, but not the more frequent problems with medication affordability. Reduced access to care and medications for an increasing number of uninsured nonelderly Americans may lead to inadequate risk factor modification and increased recurrent events in younger stroke populations that can contribute to greater costs.…”

Racial/ethnic disparities in access to physician care and medications among US stroke survivors

“…In our earlier study assessing age-related differences in access to care of US stroke survivors in NHIS years 1998 -2002, we found that black race was associated with lack of medical specialist visit but not with lack of generalist visit, perhaps owing to smaller sample size, reduced power to detect racial differences, and confounding by ethnicity and time. 15 Potential causes of racial/ethnic disparities in access to or use of physician care include differences in socioeconomic status, health care access and utilization, and community resources, differences that may not be fully captured by income and insurance. 11,21 Previous US research has found that differences in insurance, income, and available safety net services explain most differences (Ͼ80%) in access to physician care between Hispanics and whites but explain less of the access disparities between blacks and whites.…”

“…The study of age-related differences in medication access found an absence of association possibly due to insufficient power and confounding by Hispanic ethnicity. 15 In the study of regional differences in medication access, black women but not black men were more likely to be unable to afford medications after adjustment for income and insurance, possibly due to ef- Table 3 Odds ratios (95% confidence intervals) for access to physician care and medications, by age group, Mexican American and nonHispanic black vs non-Hispanic white, unadjusted, adjusted for all covariates except health insurance, and fully adjusted: National fect modification by gender and age. 14 Our finding of a nonsignificant 1.45 greater odds in adjusted inability to afford medications for blacks vs whites, in the present study, may be due to decreased power or may reflect a true attenuation of the association between being black and inability to afford medications by demographics and comorbidity.…”

“…Given general qualification for Medicare health insurance at age 65 and our previous research showing that age modifies access to physician care and medications among stroke survivors, 15 we examined frequencies of health insurance and access measures by race/ethnicity among younger (aged 45-64 years) and older (aged Ն65 years) stroke survivors.…”

Reduced Medication Access

“…Younger stroke survivors (age 45 to 64 years) have reduced access to health insurance and medications compared with older stroke survivors (age Ն65 years). 35 The CAReS study found that stroke survivors were discharged home from rehabilitation with an average of 11.3 medications (range 3 to 27). 36 Using the monthly Average Wholesale Price (2004), the total monthly cost of the 10 common prescription medications for stroke survivors was Ϸ$725.…”