Women vs Men With Premature ASCVD Report Worse Healthcare Access and Physical, Mental Health

Lonely woman with depression.
A woman sits alone in her bedroom, visibly upset.
Using data from adults with premature atherosclerotic cardiovascular disease, researchers analyzed the relationship between sex and physical and mental health, as well as health care access.

Women with premature atherosclerotic cardiovascular disease (ASCVD) are more likely than men to report worse overall physical and mental health, the inability to consult with a physician because of cost, and cost-related medical nonadherence, according to a study published in JAMA Cardiology.

The investigators sought to explore the association of sex with physical and mental health domains, as well as health care access, among adults with self-reported premature ASCVD. Researchers conducted a retrospective analysis between 2016 and 2019 using data on adults enrolled in the US Behavioral Risk Factor Surveillance System (BRFSS) survey. Participants aged 18 to 55 years were identified through the BRFSS. All relevant data were examined from June to July 2021. In this analysis, self-reported ASCVD was defined as “having a history of coronary artery disease, myocardial infarction, or stroke.” The main outcome measures of the study were self-reported physical and mental health, along with measures of health care access, which included self-reported cost-associated medication nonadherence and the inability to consult with a physician because of the cost.

Among 748,090 adults 18 to 55 years of age who were identified between 2016 and 2019, a total of 28,522 had self-reported premature ASCVD. Overall, 47.0% of the individuals identified were women. Following multivariable logistic regression analysis, women vs men with premature ASCVD were significantly more likely to report overall poor physical health (odds ratio [OR], 1.39; 95% CI, 1.09 to 1.78; P =.008), clinical depression (OR, 1.73; 95% CI, 1.41 to 2.14; P <.001), cost-related medication nonadherence (OR, 1.42; 95% CI, 1.11 to 1.82; P =.005), and the inability to consult with a physician because of cost-related issues (OR, 4,52; 95% CI, 2.24 to 9.13; P <.001).

These findings were in spite of the fact that women were statistically significantly more likely than men to have health care coverage (85.3% vs 80.8%, respectively; P =.04) and to have a primary care physician (84.2% vs 75.7%, respectively; P <.001).

The researchers concluded that the results from the current study show that interventions designed to address mental health and out-of-pocket costs are greatly needed in the adult patient population with premature ASCVD.

“These findings underscore the importance of narrowing cardiovascular disparities by encouraging policy-level efforts that advocate for integrating social determinants of health into existing clinical delivery support systems and promote investments in developing social risk assessment tools that enable physicians to specifically target this vulnerable population,” the study authors noted. “Lastly, our results highlight the need for policy-level interventions to address out-of-pocket costs for this young patient population.”

Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures. 


Jain V, Al Rifai M, Turpin R, et al. Evaluation of factors underlying sex-based disparities in cardiovascular care in adults with self-reported premature atherosclerotic cardiovascular disease. JAMA Cardiol. Published online January 5, 2022. doi:10.1001/jamacardio.2021.5430.