Insurance and prehospital delay in patients ≤55 years with acute myocardial infarction

Serene I. Chen, Yongfei Wang, Rachel Dreyer, Kelly M. Strait, Erica S. Spatz, Xiao Xu, K.G.E. Smolderen, Nihar R. Desai, Nancy P. Lorenze, Judith H. Lichtman, John A. Spertus, Gail D'onofrio, Héctor Bueno, Frederick A. Masoudi, Harlan M. Krumholz

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Abstract

This prospective study assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for US patients 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 18–55 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 relationship 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% versus 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, though 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. Keywords: Prehospital delay, acute myocardial infarction, health insurance, multinational study
Original languageEnglish
Pages (from-to)1827-1832
JournalAmerican Journal of Cardiology
Volume116
Issue number12
DOIs
Publication statusPublished - 1 Dec 2015

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Chen, S. I., Wang, Y., Dreyer, R., Strait, K. M., Spatz, E. S., Xu, X., ... Krumholz, H. M. (2015). Insurance and prehospital delay in patients ≤55 years with acute myocardial infarction. American Journal of Cardiology, 116(12), 1827-1832. https://doi.org/10.1016/j.amjcard.2015.09.018
Chen, Serene I. ; Wang, Yongfei ; Dreyer, Rachel ; Strait, Kelly M. ; Spatz, Erica S. ; Xu, Xiao ; Smolderen, K.G.E. ; Desai, Nihar R. ; Lorenze, Nancy P. ; Lichtman, Judith H. ; Spertus, John A. ; D'onofrio, Gail ; Bueno, Héctor ; Masoudi, Frederick A. ; Krumholz, Harlan M. / Insurance and prehospital delay in patients ≤55 years with acute myocardial infarction. In: American Journal of Cardiology. 2015 ; Vol. 116, No. 12. pp. 1827-1832.
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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 US patients 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 18–55 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 relationship 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{\%} versus 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, though 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. Keywords: Prehospital delay, acute myocardial infarction, health insurance, multinational study",
author = "Chen, {Serene I.} and Yongfei Wang and Rachel Dreyer and Strait, {Kelly M.} and Spatz, {Erica S.} and Xiao Xu and K.G.E. Smolderen and Desai, {Nihar R.} and Lorenze, {Nancy P.} and Lichtman, {Judith H.} and Spertus, {John A.} and Gail D'onofrio and H{\'e}ctor Bueno and Masoudi, {Frederick A.} and Krumholz, {Harlan M.}",
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Chen, SI, Wang, Y, Dreyer, R, Strait, KM, Spatz, ES, Xu, X, Smolderen, KGE, Desai, NR, Lorenze, NP, Lichtman, JH, Spertus, JA, D'onofrio, G, Bueno, H, Masoudi, FA & Krumholz, HM 2015, 'Insurance and prehospital delay in patients ≤55 years with acute myocardial infarction', American Journal of Cardiology, vol. 116, no. 12, pp. 1827-1832. https://doi.org/10.1016/j.amjcard.2015.09.018

Insurance and prehospital delay in patients ≤55 years with acute myocardial infarction. / Chen, Serene I.; Wang, Yongfei; Dreyer, Rachel; Strait, Kelly M.; Spatz, Erica S.; Xu, Xiao; Smolderen, K.G.E.; Desai, Nihar R.; Lorenze, Nancy P.; Lichtman, Judith H.; Spertus, John A.; D'onofrio, Gail; Bueno, Héctor; Masoudi, Frederick A.; Krumholz, Harlan M.

In: American Journal of Cardiology, Vol. 116, No. 12, 01.12.2015, p. 1827-1832.

Research output: Contribution to journalArticleScientificpeer-review

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T1 - Insurance and prehospital delay in patients ≤55 years with acute myocardial infarction

AU - Chen, Serene I.

AU - Wang, Yongfei

AU - Dreyer, Rachel

AU - Strait, Kelly M.

AU - Spatz, Erica S.

AU - Xu, Xiao

AU - Smolderen, K.G.E.

AU - Desai, Nihar R.

AU - Lorenze, Nancy P.

AU - Lichtman, Judith H.

AU - Spertus, John A.

AU - D'onofrio, Gail

AU - Bueno, Héctor

AU - Masoudi, Frederick A.

AU - Krumholz, Harlan M.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - This prospective study assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for US patients 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 18–55 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 relationship 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% versus 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, though 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. Keywords: Prehospital delay, acute myocardial infarction, health insurance, multinational study

AB - This prospective study assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for US patients 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 18–55 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 relationship 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% versus 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, though 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. Keywords: Prehospital delay, acute myocardial infarction, health insurance, multinational study

U2 - 10.1016/j.amjcard.2015.09.018

DO - 10.1016/j.amjcard.2015.09.018

M3 - Article

VL - 116

SP - 1827

EP - 1832

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

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