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

Research output: Contribution to journalArticleScientificpeer-review

7 Citations (Scopus)


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
Issue number12
Publication statusPublished - 1 Dec 2015


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