title: Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction.
abstract: Financial barriers to health care are associated with worse outcomes following acute myocardial infarction (AMI). Yet, it is unknown whether the prevalence of financial barriers and their relationship with post-AMI outcomes vary by sex among young adults.
  
  
  
  We assessed sex differences in patient-reported financial barriers among adults aged <55 years with AMI using data from the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients study. We examined the prevalence of financial barriers and their association with health status 12 months post-AMI. Among 3437 patients, more women than men reported financial barriers to medications (22.3% vs 17.2%; P=0.001), but rates of financial barriers to services were similar (31.3% vs 28.9%; P=0.152). In multivariable linear regression models adjusting for baseline health, psychosocial status, and clinical characteristics, compared with no financial barriers, women and men with financial barriers to services and medications had worse mental functional status (Short Form-12 mental health score: mean difference [MD]=-3.28 and -3.35, respectively), greater depressive symptomatology (Patient Health Questionnaire-9: MD, 2.18 and 2.16), lower quality of life (Seattle Angina Questionnaire-Quality of Life: MD, -4.98 and -7.66), and higher perceived stress (Perceived Stress Score: MD, 3.76 and 3.90; all P<0.05). There was no interaction between sex and financial barriers.
  
  
  
  Financial barriers to care are common in young patients with AMI and associated with worse health outcomes 1 year post-AMI. Whereas women experienced more financial barriers than men, the association did not vary by sex. These findings emphasize the importance of addressing financial barriers to recovery post-AMI in young adults.
authors.affiliation: Yale College, New Haven, CT.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Beckman
authors.affiliation: Department of Medicine, Boston Children's Hospital, Boston, MA.
authors.forename: Emily M
authors.initials: EM
authors.lastname: Bucholz
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, CT.
authors.forename: Xiao
authors.initials: X
authors.lastname: Xu
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Dreyer
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT.
authors.forename: Kelly M
authors.initials: KM
authors.lastname: Strait
authors.affiliation: Mid-America Heart Institute, University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, CT Department of Health Policy and Management, Yale School of Public Health, New Haven, CT.
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT erica.spatz@yale.edu.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Spatz
mesh_terms: D000328:Adult; D000359:Aftercare / Q000191:economics; D003863:Depression; D016527:Drug Costs; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007182:Income; D016014:Linear Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction; D000073222:Patient Health Questionnaire; D011446:Prospective Studies; D020127:Recovery of Function; D012737:Sex Factors; D012959:Socioeconomic Factors; D013030:Spain; D014481:United States
keywords: epidemiology; myocardial infarction; risk factors; women