Evaluation of factors underlying sex-based disparities in cardiovascular care in adults with self-reported premature atherosclerotic cardiovascular disease

Vardhmaan Jain, Cleveland Clinic Foundation
Mahmoud Al Rifai, Baylor College of Medicine
Rodman Turpin, University of Maryland
Hatice Nur Eken, Vanderbilt University School of Medicine
Ankit Agrawal, Cleveland Clinic Foundation
Dhruv Mahttaf, Baylor College of Medicine
Zainab Samad, Aga Khan University
Stephanie Coulter, Texas Heart Institute
Fatima Rodriguez, Stanford University School of Medicine
Laura A. Petersen, Baylor College of Medicine

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Importance: There are limited data regarding sex-based differences in physical and mental health domains and health care access in adults with premature atherosclerotic cardiovascular disease (ASCVD).
Objective: To study the association of sex with physical and mental health domains as well as health care access-related factors among adults with self-reported premature ASCVD.
Design, setting, and participants: Retrospective cohort analysis of 748 090 adults aged 18 to 55 years in the Behavioral Risk Factor Surveillance System 2016 to 2019 in the US. Data were analyzed from June to July 2021.
Exposures: Self-reported ASCVD, defined as having a history of coronary artery disease, myocardial infarction, or stroke.
Main outcomes and measures: Self-reported physical and mental health and measures of health care access, including self-reported cost-related medication nonadherence and inability to see a physician due to cost.
Results: Between 2016 and 2019, 748 090 adults aged 18-55 years were identified, of whom 28 522 (3.3%) had self-reported premature ASCVD. Of these, 14 358 (47.0%) were women. Compared with men, women with premature ASCVD were more likely to report being clinically depressed (odds ratio [OR], 1.73; 95% CI, 1.41-2.14; P < .001), have cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11-1.82; P = .005), have not seen a physician due to cost-related issues (OR, 4.52; 95% CI, 2.24-9.13; P < .001), and were more likely to report overall poor physical health (OR, 1.39; 95% CI, 1.09-1.78; P = .008) despite being more likely to have health care coverage (85.3% vs 80.8%; P = .04) and a primary care physician (84.2% vs 75.7%; P < .001).
Conclusions and relevance: Results from this study indicate that women with premature ASCVD were more likely to report worse overall physical and mental health, inability to see a physician due to cost, and cost-related medical nonadherence. Interventions addressing mental health and out-of-pocket costs are needed in adults with premature ASCVD.