Abstract 7: Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction
Authors: Beckman Adam L , Bucholz Emily M , Zhang Weiwei , Xu Xiao , Dreyer Rachel P , Strait Kelly M , Spatz Erica S , Spertus John A , Krumholz Harlan M 
Published: March 2022

Background:
Financial barriers to healthcare services and medications have been associated with worse outcomes following acute myocardial infarction (AMI). Their prevalence and impact may be even greater in younger adults without access to Medicare and, specifically, in young women, who are more likely than men to forego needed medical care in the face of economic hardship. We assessed sex differences in the prevalence and potency of financial barriers in young patients with AMI and whether they help explain poorer outcomes in women.

Methods:
We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, the largest multicenter prospective study of young adults (≤55 years old) with AMI. Patients were characterized as having financial barriers to medications, services, both, or none based on self-report responses at the index hospitalization for AMI. One-year outcomes after AMI were assessed including general health status (Short Form-12 physical and mental health component scores) and angina-related quality of life (Seattle Angina Questionnaire). Multivariable linear regression was used to examine the relationship between financial barriers and outcomes, testing for interactions with sex. All models were adjusted for baseline health status, socio-demographics, comorbidities, clinical presentation, and inpatient care. In a secondary analysis, we investigated the unadjusted association of financial barriers with healthcare access and utilization at 1-month.

Results:
Of the 3437 patients in the study, financial barriers to healthcare services (30.5%) and medications (20.6%) were common. Significantly more women than men reported financial barriers to medication (22.3% vs. 17.2%, P < 0.01). Compared with patients reporting no financial barriers, patients with financial barriers to both services and medications were more likely to have lower physical health (mean difference (MD) = -2.87, P < 0.001), lower mental health (MD= -3.14, P < 0.001), and lower quality of life (MD = -5.81, P < 0.001) one year post-AMI. No sex difference in the effect of financial barriers on health outcomes was observed (interaction P > 0.1 for all outcomes). Rates of 1-month healthcare access and utilization were similar in men and women. However, 1-month after AMI, patients with at least one financial barrier reported significantly lower adherence to medications, higher rates of not participating in cardiac rehabilitation after referral, and greater difficulty scheduling follow-up visits than patients with no financial barriers.

Conclusion:
Financial barriers are common among young adults and are associated with worse health outcomes 1-year after AMI. While the potency of financial barriers on health outcomes did not vary by sex, the greater prevalence of financial barriers among women may in part explain why young women have worse outcomes than their male peers.