Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction

Area of Science:

• Cardiology
• Health Services Research
• Sociology

Background:

• Gender disparities exist in healthcare access and outcomes.
• Prehospital delay in seeking care for acute myocardial infarction (AMI) is a critical factor influencing patient prognosis.
• Health insurance status is a potential determinant of healthcare-seeking behavior.

Purpose of the Study:

• To investigate whether gender differences in health insurance explain gender differences in prehospital delay for AMI patients in the US.
• To compare gender differences in prehospital delay for AMI in the US and Spain, a country with universal insurance.
• To explore the association between insurance status and delayed care-seeking among AMI patients in the US.

Main Methods:

• Prospective study design involving 2,951 US patients and 496 Spanish patients (aged 18-55) with AMI.
• US patients categorized by insurance status: adequately insured, underinsured, or uninsured.
• Analysis of the association between gender and prehospital delay (symptom onset to hospital arrival), and modeling of delays >12 hours in relation to insurance status.

Main Results:

• US women were less likely to be uninsured but more likely to be underinsured than men.
• A higher proportion of US women (38%) than men (29%) experienced prehospital delays of >12 hours for AMI.
• No significant association was found between insurance status and delays >12 hours for either gender in the US.
• In Spain, only 17.3% of patients experienced delays >12 hours, with no significant gender differences.

Conclusions:

• Women are more likely than men to experience prehospital delays in seeking care for AMI.
• These gender-related delays in the US are not explained by differences in health insurance status.
• The absence of gender differences in prehospital delays in Spain suggests that healthcare systems and cultural factors significantly influence these disparities.