Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio.
Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.
JAMA Cardiol. 2022 Mar 1;7(3):341-345. doi: 10.1001/jamacardio.2021.5430.
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).
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.
Self-reported ASCVD, defined as having a history of coronary artery disease, myocardial infarction, or stroke.
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.
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).
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.
在患有早发性动脉粥样硬化性心血管疾病（ASCVD）的成年人中，关于性别与身心健康领域以及医疗保健获取相关因素的差异的数据有限。
研究报告的早发性 ASCVD 成年人中，性别与身心健康领域以及与医疗保健获取相关因素的关联。
设计、设置和参与者：在美国行为风险因素监测系统 2016 年至 2019 年期间，对 748090 名年龄在 18 至 55 岁之间的成年人进行了回顾性队列分析。数据于 2021 年 6 月至 7 月进行分析。
自我报告的 ASCVD，定义为有冠心病、心肌梗死或中风病史。
自我报告的身心健康以及医疗保健获取措施，包括自我报告的因费用而无法坚持药物治疗和因费用而无法看医生。
2016 年至 2019 年间，确定了 748090 名 18-55 岁的成年人，其中 28522 名（3.3%）有早发性 ASCVD。其中，14358 名（47.0%）为女性。与男性相比，患有早发性 ASCVD 的女性更有可能报告患有临床抑郁症（比值比[OR]，1.73；95%置信区间[CI]，1.41-2.14；P<0.001）、因费用相关而无法坚持药物治疗（OR，1.42；95% CI，1.11-1.82；P=0.005）、因费用相关问题而无法看医生（OR，4.52；95% CI，2.24-9.13；P<0.001），并且更有可能报告整体健康状况较差（OR，1.39；95% CI，1.09-1.78；P=0.008），尽管她们更有可能拥有医疗保险（85.3%对 80.8%；P=0.04）和初级保健医生（84.2%对 75.7%；P<0.001）。
本研究结果表明，患有早发性 ASCVD 的女性更有可能报告整体身心健康状况较差、因费用而无法看医生以及因费用而无法坚持药物治疗。在患有早发性 ASCVD 的成年人中，需要针对心理健康和自付费用采取干预措施。
