title: Self-reported delays in receipt of health care among women with diabetes and cardiovascular conditions.
abstract: OBJECTIVE
  Midlife and older adults have high rates of chronic conditions, and differences in health insurance coverage may affect their access to care. Women may be particularly at risk for access problems. This study examines the association of gender and health insurance status with delays in care, a dimension of access to care, among midlife (age 45-64) and older (age > or = 65) adults with diabetes and cardiovascular conditions.
  
  
  METHODS
  Data were from the 2004 through 2006 national Medical Expenditure Panel Survey. A total of 4,706 adults with self-identified diabetes and 17,636 adults with self-identified cardiovascular conditions, aged 45 years and older, were included. The analyses examined associations of gender and insurance status with self-reported delays in medical care, dental care, prescription medication, and illness/injury care, using bivariate and multivariate analyses adjusted for race/ethnicity, education, income, and perceived health status.
  
  
  RESULTS
  Midlife women with diabetes or cardiovascular conditions were more likely to report delays in care than men, even after adjusting for key factors (85%-111% higher odds of delays among diabetes patients, 56%-84% higher odds of delays among cardiovascular patients; all p < .01). Many, but not all, of these gender differences were eliminated among Medicare-insured older adults. Among midlife adults, health insurance coverage differences were also significantly associated with delays in care.
  
  
  CONCLUSIONS
  Women are more likely to experience delays in health care, even after adjusting for health coverage. Efforts are needed to understand factors that influence gender differences in these delays and to determine whether policy reforms eliminate or exacerbate these differences.
authors.affiliation: The National Committee for Quality Assurance, 1100 13th Street, NW, Suite 1000,Washington, DC 20005, USA. ng@ncqa.org
authors.forename: Judy H
authors.initials: JH
authors.lastname: Ng
authors.forename: Shakeh J
authors.initials: SJ
authors.lastname: Kaftarian
authors.forename: Wilma M
authors.initials: WM
authors.lastname: Tilson
authors.forename: Paul
authors.initials: P
authors.lastname: Gorrell
authors.forename: Xiuhua
authors.initials: X
authors.lastname: Chen
authors.forename: Francis D
authors.initials: FD
authors.lastname: Chesley
authors.forename: Sarah Hudson
authors.initials: SH
authors.lastname: Scholle
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D011314:Preventive Health Services / Q000458:organization & administration; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D016387:Women's Health; D014932:Women's Health Services / Q000458:organization & administration