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Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction.

Publication ,  Journal Article
Smolderen, KG; Spertus, JA; Nallamothu, BK; Krumholz, HM; Tang, F; Ross, JS; Ting, HH; Alexander, KP; Rathore, SS; Chan, PS
Published in: JAMA
April 14, 2010

CONTEXT: Little is known about how health insurance status affects decisions to seek care during emergency medical conditions such as acute myocardial infarction (AMI). OBJECTIVE: To examine the association between lack of health insurance and financial concerns about accessing care among those with health insurance, and the time from symptom onset to hospital presentation (prehospital delays) during AMI. DESIGN, SETTING, AND PATIENTS: Multicenter, prospective study using a registry of 3721 AMI patients enrolled between April 11, 2005, and December 31, 2008, at 24 US hospitals. Health insurance status was categorized as insured without financial concerns, insured but have financial concerns about accessing care, and uninsured. Insurance information was determined from medical records while financial concerns among those with health insurance were determined from structured interviews. MAIN OUTCOME MEASURE: Prehospital delay times (< or = 2 hours, > 2-6 hours, or > 6 hours), adjusted for demographic, clinical, and social and psychological factors using hierarchical ordinal regression models. RESULTS: Of 3721 patients, 2294 were insured without financial concerns (61.7%), 689 were insured but had financial concerns about accessing care (18.5%), and 738 were uninsured (19.8%). Uninsured and insured patients with financial concerns were more likely to delay seeking care during AMI and had prehospital delays of greater than 6 hours among 48.6% of uninsured patients and 44.6% of insured patients with financial concerns compared with only 39.3% of insured patients without financial concerns. Prehospital delays of less than 2 hours during AMI occurred among 36.6% of those insured without financial concerns compared with 33.5% of insured patients with financial concerns and 27.5% of uninsured patients (P < .001). After adjusting for potential confounders, prehospital delays were associated with insured patients with financial concerns (adjusted odds ratio, 1.21 [95% confidence interval, 1.05-1.41]; P = .01) and with uninsured patients (adjusted odds ratio, 1.38 [95% confidence interval, 1.17-1.63]; P < .001). CONCLUSION: Lack of health insurance and financial concerns about accessing care among those with health insurance were each associated with delays in seeking emergency care for AMI.

Duke Scholars

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Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

April 14, 2010

Volume

303

Issue

14

Start / End Page

1392 / 1400

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Registries
  • Prospective Studies
  • Patient Acceptance of Health Care
  • Myocardial Infarction
  • Middle Aged
  • Medically Uninsured
  • Male
  • Insurance, Health
 

Citation

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Smolderen, K. G., Spertus, J. A., Nallamothu, B. K., Krumholz, H. M., Tang, F., Ross, J. S., … Chan, P. S. (2010). Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. JAMA, 303(14), 1392–1400. https://doi.org/10.1001/jama.2010.409
Smolderen, Kim G., John A. Spertus, Brahmajee K. Nallamothu, Harlan M. Krumholz, Fengming Tang, Joseph S. Ross, Henry H. Ting, Karen P. Alexander, Saif S. Rathore, and Paul S. Chan. “Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction.JAMA 303, no. 14 (April 14, 2010): 1392–1400. https://doi.org/10.1001/jama.2010.409.
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, et al. Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. JAMA. 2010 Apr 14;303(14):1392–400.
Smolderen, Kim G., et al. “Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction.JAMA, vol. 303, no. 14, Apr. 2010, pp. 1392–400. Pubmed, doi:10.1001/jama.2010.409.
Smolderen KG, Spertus JA, Nallamothu BK, Krumholz HM, Tang F, Ross JS, Ting HH, Alexander KP, Rathore SS, Chan PS. Health care insurance, financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction. JAMA. 2010 Apr 14;303(14):1392–1400.
Journal cover image

Published In

JAMA

DOI

EISSN

1538-3598

Publication Date

April 14, 2010

Volume

303

Issue

14

Start / End Page

1392 / 1400

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Registries
  • Prospective Studies
  • Patient Acceptance of Health Care
  • Myocardial Infarction
  • Middle Aged
  • Medically Uninsured
  • Male
  • Insurance, Health