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Background: In patients with atherosclerotic cardiovascular disease (ASCVD), barriers related to transportation may impair access to care, with potential implications for prognosis. Although few studies have explored transportation barriers among patients with ASCVD, the correlates of delayed care due to transportation barriers have not been examined in this population. We aimed to examine this in U.S. patients with ASCVD using nationally representative data., Methods: Using data from the 2009-2018 National Health Interview Survey, we estimated the self-reported prevalence of delayed medical care due to transportation barriers among adults with ASCVD, overall and by sociodemographic characteristics. Logistic regression was used to examine the association between various sociodemographic characteristics and delayed care due to transportation barriers., Results: Among adults with ASCVD, 4.5% (95% CI; 4.2, 4.8) or ∼876,000 annually reported delayed care due to transportation barriers. Income (low-income: odds ratio [OR] 4.43, 95% CI [3.04, 6.46]; lowest-income: OR 6.35, 95% CI [4.36, 9.23]) and Medicaid insurance (OR 4.53; 95% CI [3.27, 6.29]) were strongly associated with delayed care due to transportation barriers. Additionally, younger individuals, women, non-Hispanic Black adults, and those from the U.S. South or Midwest, had higher odds of reporting delayed care due to transportation barriers., Conclusions: Approximately 5% of adults with ASCVD experience delayed care due to transportation barriers. Vulnerable groups include young adults, women, low-income people, and those with public/no insurance. Future studies should analyze the feasibility and potential benefits of interventions such as use of telehealth, mobile clinics, and provision of transportation among patients with ASCVD in the U.S., Competing Interests: Conflict of interest Dr Nasir is on the advisory board of Amgen, Novartis, Medicine Company, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. No other conflicts of interest relevant to the content of this manuscript were reported by the authors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background Atherosclerotic cardiovascular disease (ASCVD) results in high out-of-pocket healthcare expenditures predisposing to food insecurity. However, the burden and determinants of food insecurity in this population are unknown. Methods and Results Using 2013 to 2018 National Health Interview Survey data, we evaluated the prevalence and sociodemographic determinants of food insecurity among adults with ASCVD in the United States. ASCVD was defined as self-reported diagnosis of coronary heart disease or stroke. Food security was measured using the 10-item US Adult Food Security Survey Module. Of the 190 113 study participants aged 18 years or older, 18 442 (adjusted prevalence 8.2%) had ASCVD, representing ≈20 million US adults annually. Among adults with ASCVD, 2968 or 14.6% (weighted ≈2.9 million US adults annually) reported food insecurity compared with 9.1% among those without ASCVD ( P <0.001). Individuals with ASCVD who were younger (odds ratio [OR], 4.0 [95% CI, 2.8-5.8]), women (OR, 1.2 [1.0-1.3]), non-Hispanic Black (OR, 2.3 [1.9-2.8]), or Hispanic (OR, 1.6 [1.2-2.0]), had private (OR, 1.8 [1.4-2.3]) or no insurance (OR, 2.3 [1.7-3.1]), were divorced/widowed/separated (OR, 1.2 [1.0-1.4]), and had low family income (OR, 4.7 [4.0-5.6]) were more likely to be food insecure. Among those with ASCVD and 6 of these high-risk characteristics, 53.7% reported food insecurity and they had 36-times (OR, 36.2 [22.6-57.9]) higher odds of being food insecure compared with those with ≤1 high-risk characteristic. Conclusion About 1 in 7 US adults with ASCVD experience food insecurity, with more than 1 in 2 adults reporting food insecurity among the most vulnerable sociodemographic subgroups. There is an urgent need to address the barriers related to food security in this population.

Background Atherosclerotic cardiovascular disease ( ASCVD ) accounts for approximately one third of deaths in women. Although there is an established relationship between positive patient experiences, health-related quality of life, and improved health outcomes, little is known about gender differences in patient-reported outcomes among ASCVD patients. We therefore compared gender differences in patient-centered outcomes among individuals with ASCVD . Methods and Results Data from the 2006 to 2015 Medical Expenditure Panel Survey, a nationally representative US sample, were used for this study. Adults ≥18 years with a diagnosis of ASCVD , ascertained by International Classification of Diseases, Ninth Revision ( ICD-9) codes and/or self-reported data, were included. Linear and logistic regression were used to compare self-reported patient experience, perception of health, and health-related quality of life by gender. Models adjusted for demographics, socioeconomic status, and comorbidities. There were 21 353 participants included, with >10 000 (47%-weighted) of the participants being women, representing ≈11 million female adults with ASCVD nationwide. Compared with men, women with ASCVD were more likely to experience poor patient-provider communication (odds ratio 1.25 [95% confidence interval 1.11-1.41]), lower healthcare satisfaction (1.12 [1.02-1.24]), poor perception of health status (1.15 [1.04-1.28]), and lower health-related quality of life scores. Women with ASCVD also had lower use of aspirin and statins, and greater odds of ≥2 Emergency Department visits/y. Conclusions Women with ASCVD were more likely to report poorer patient experience, lower health-related quality of life, and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender-specific differences in healthcare quality, delivery, and ultimately health outcomes among individuals with ASCVD .

Introduction: Emerging evidence suggest a substantial proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience financial hardship from cumulative out-of-pocket healthcare expenses. In this study, we aim to examine the relationship between financial hardship and health-related quality of life (HRQOL), self-perception of health, psychological distress, and depression from a nationally representative adult population with established ASCVD. Methods: Data on patients with ASCVD was obtained from the 2006 to 2015 Medical Expenditure Panel Survey to assess annual inflation-adjusted out-of-pocket expenses, inclusive of insurance premiums, for all patients with ASCVD. High financial burden (HFB) and catastrophic healthcare expenditure (CHE) were defined as a ratio of annual family out-of-pocket health care expenditures to family income 20-40% and > 40%, respectively. HRQOL was assessed from the Short-Form 12 Health Survey Version 2. Non-psychological distress, measured by the Kessler Index, whereas the risk of depression was assessed via the Patient Health Questionnaire (PHQ-2). Results: Of total 20,131 individuals with established ASCVD, 7.8% and 7.2% experienced HFB and CHE, respectively, representing annualized 3.3 million individuals. In multivariate analysis, ASCVD patients among families suffering from CHE reported significantly lower HRQOL [OR 1.30, 95% CI 1.10, 1.54], higher odds for psychological distress [OR 1.26, 95% CI 1.02, 1.57], worse self-perception of health [OR 1.26, 95% CI 1.08, 1.46], and higher likelihood of risk or clinical depression [OR 1.18, 95% CI 1.01, 1.38]. Conclusions: Financial burden among patients with ASCVD was significantly associated with worse quality of life, self-perception of health and mental health outcomes. Interventions are needed to ensure optimal screening, prevention and detection for at risk ASCVD patients in general, especially those with financial hardships. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic cardiovascular disease (ASCVD), a leading cause of morbidity and mortality, accounts for at least one-third of deaths in women worldwide. Although there is an established relationship between positive patient experiences, health-related quality of life (HRQoL) and improved health outcomes, little is known about the gender differences in patient-reported outcomes among ASCVD patients. We therefore compare gender-differences in patient-centered outcomes among individuals with ASCVD. Methods: Data from the Medical Expenditure Panel Survey (MEPS) 2006-2015, a nationally representative U.S. sample, was used to carry out this study. Adults ≥18 years with a diagnosis of ASCVD, ascertained by ICD9 codes and/or self-reported data, were included and stratified by gender. Linear and logistic regression analyses were used to compare patient experience, perception of health, and HRQoL by gender. The regression models were adjusted for socio-demographic characteristics and comorbidities. Results: 21,353 participants were included in this study, with over 10,000 (47%-weighted) of the participants being women - representing approximately 11 million female adults with ASCVD nationwide. Compared with men, a greater proportion of women with ASCVD reported poor health outcomes (figure). Furthermore, women with ASCVD were more likely to experience poor patient provider communication [OR 1.25 (95% CI 1.11, 1.41)], poor patient satisfaction [1.12 (1.02, 1.24)], poor perception of health status [1.15 (1.04, 1.28)], and have lower HRQoL scores (Table). Conclusion: Women with ASCVD were more likely to have a poor patient experience, lower HRQoL and poorer perception of their health when compared with men. These findings have important public health implications and require more research towards understanding the gender-specific differences in healthcare quality, delivery and ultimately health outcomes among individuals with ASCVD. [ABSTRACT FROM AUTHOR]