title: 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 patients in the US, 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 to 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 relation 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% vs 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, although 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.
authors.affiliation: Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Serene I
authors.initials: SI
authors.lastname: Chen
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Rachel
authors.initials: R
authors.lastname: Dreyer
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: Kim G
authors.initials: KG
authors.lastname: Smolderen
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Nihar R
authors.initials: NR
authors.lastname: Desai
authors.affiliation: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Lorenze
authors.affiliation: Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.affiliation: Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
authors.forename: Gail
authors.initials: G
authors.lastname: D'Onofrio
authors.affiliation: Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de investigación i + 12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. Electronic address: harlan.krumholz@yale.edu.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000293:Adolescent; D000328:Adult; D003695:Delivery of Health Care / Q000191:economics*; D004632:Emergency Medical Services / Q000191:economics*; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality / Q000628:therapy; D010343:Patient Admission / Q000191:economics / Q000639:trends*; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult