This Article  • Full text  • PDF  • CME Course for This Article  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (3)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Caring for the Uninsured and Underinsured  • Cerebrovascular Disease  • Stroke  • Neurology, Other  • Alert me on articles by topic

National Health Interview Survey From Years 1998 to 2002

Deborah A. Levine, MD, MPH; Catarina I. Kiefe, PhD, MD; Thomas K. Houston, MD, MPH; Jeroan J. Allison, MD, MSc; Ellen P. McCarthy, PhD; John Z. Ayanian, MD, MPP

Arch Neurol. 2007;64(1):37-42. Published online November 13, 2006 (doi:10.1001/archneur.64.1.noc60002).

Background  More than 5 million US stroke survivors require comprehensive care for risk factor modification and secondary prevention. Younger stroke survivors may have reduced access to physician care and medications because they are more frequently uninsured.

Objective  To assess age-related differences in access to physician care and medications among stroke survivors (aged 45-64 years vs 65 years).

Design  National Health Interview Survey from years 1998 to 2002.

Setting  A US population-based survey.

Participants  Stroke survivors (n = 3681) aged 45 years and older among 159 985 survey respondents.

Main Outcome Measures  General doctor visit, medical specialist visit, and inability to afford medications within the last 12 months.

Results  Compared with older stroke survivors, younger stroke survivors more frequently reported no general doctor visit (10% vs 14%, respectively; P = .002), no general doctor or medical specialist visit (5% vs 8%, respectively; P = .003), and the inability to afford medications (6% vs 15%, respectively; P<.001). Younger age was independently associated with no general doctor visit (odds ratio, 1.40; 95% confidence interval, 1.04-1.88), no general doctor or medical specialist visit (odds ratio, 1.69; 95% confidence interval, 1.14-2.52), and the inability to afford medications (odds ratio, 2.94; 95% confidence interval, 2.19-3.94) after adjusting for sex, race, income, neurological disability, health status, and comorbidity. With further adjustment for health insurance, younger age remained independently associated with the inability to afford medications but not the lack of physician visits.

Conclusions  Stroke survivors younger than 65 years reported worse access to physician care and medication affordability than older stroke survivors. Inadequate access among younger stroke survivors may lead to inadequate risk factor modification and recurrent cardiovascular events.

Author Affiliations: Deep South Center on Effectiveness Research, Birmingham Veterans Affairs Medical Center, and Department of Medicine, University of Alabama at Birmingham (Drs Levine, Kiefe, Houston, and Allison); and Beth Israel Deaconess Medical Center (Dr McCarthy), Division of General Medicine, Brigham and Women's Hospital (Dr Ayanian), and Department of Health Care Policy (Dr Ayanian), Harvard Medical School, Boston, Mass.

RELATED ARTICLE

The Interplay of Age, Access to Health Care, and Insurance Status: The Good, the Bad, and the Ugly
Steven R. Levine
Arch Neurol. 2007;64(1):15-16.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

The Interplay of Age, Access to Health Care, and Insurance Status: The Good, the Bad, and the Ugly
Levine
Arch Neurol 2007;64:15-16.
FULL TEXT