Abstract 106: Association between Insurance Status and Presentation Delay in Young Patients with Acute Myocardial Infarction: Insights from the VIRGO Study

Abstract

Background: Lacking health insurance and having financial concerns are known barriers to emergency care access in patients with AMI. However we do not know whether being uninsured or underinsured is associated with increased prehospital delay among young adults specifically, and whether this relationship varies by gender. Methods: We used data from the VIRGO study, a multicenter prospective study of women and men aged 18-55y with AMI (3,572). We excluded non-US patients (587) and those with unknown prehospital delay time (32) or insurance status (2). Participants were divided into 3 groups by health insurance status: 1. uninsured; 2. underinsured (insured but avoided care or medications due to cost concerns); 3. adequately insured (insured and without the above concerns). Prehospital delay was defined as the time interval between symptom onset and hospital presentation. The association between insurance groups and prehospital delay of >12 hours was examined using chi-square test. A hierarchical logistic model was used to evaluate the independent effect of insurance groups on prehospital delay of >12 hours adjusting for site clustering, demographics, medical history and clinical characteristics. Results: Of the 2951 young individuals with AMI in our study, 1987 were women (67.3%); the median age was 48 (IQR= 44, 52); 38% were underinsured; and 23%, uninsured. While women were less likely than men to be uninsured (21.8 vs 25.4%, P=0.03), they were more likely to be underinsured (60.5 vs 53.6%, P12 hours of prehospital delay: 38% of women and 29% of men (P=0.0001; figure). Insurance status was not associated with delays of >12 hrs in women (P=0.10) or men (P=0.57). After adjustments, the underinsured (OR 0.99; 95%CI 0.81, 1.19) and uninsured (OR 1.11; 95% CI 0.88, 1.39) did not have higher odds of having >12 hrs of prehospital delay compared to the adequately insured. Conclusion: More than 1 in 3 young individuals with AMI presented to hospitals beyond 12 hours after onset of symptoms. Insurance status was not associated with prehospital delays in this population. Although women are more likely to have >12 hours of prehospital delay, this difference is not attributable to differences in insurance status. Factors beyond the provision of insurance will need to be addressed to reduce delays.