Abstract 18303: Impact of Financial Barriers on Aspirin Use in Diabetic Adults with Coronary Artery Disease
Introduction: Regular aspirin use results in a marked reduction in adverse cardiovascular events in patients with diabetes and documented coronary artery disease (CAD). We sought to describe the clinical characteristics and management of diabetic patients with CAD who had financial barriers to medical care and determine if these financial barriers were predictive of aspirin use in this population.
Methods: The 2007 Centers for Disease Control's Behavioral Risk Factor Surveillance Survey was utilized to identify a cohort of 11,304 diabetic patients with CAD. Demographic data, clinical history and medication use were recorded in these patients. The primary outcome of interest was regular aspirin use.
Results: Of 11,304 patients, 1,861 (16.5%) patients reported being uninsured or as having financial barriers to medical care (underinsured) and 9,443 (83.5%) were insured with no financial barriers. The uninsured/underinsured patients tended to be younger (60 vs 68 years, p<0.001), female (57% vs 50%, p<0.001), unmarried, less educated, and with lower salaries. They also had higher rates of obesity (56% vs 50%, p<0.001), smoking (43% vs 23%, p<0.001), and prior stroke (24% vs 20%, p<0.001). The uninsured/underinsured reported lower rates of cholesterol screening (95% vs 98%, p<0.001), eye exams (61% vs 76%, p<0.001), and diabetic education classes (52% vs 55%, p<0.001). They also had significantly higher rates of hypercholesterolemia (77% vs 63%, p=0.002), diabetic retinopathy (38% vs 28%, p<0.001) and poorly healing foot ulcers (25% vs 14%, p<0.001). Antihypertensive medication (91% vs 96%, p<0.001) and regular aspirin use (70% vs 77%, p<0.001) was less common in the uninsured/underinsured. In multivariate analysis, uninsured/underinsured status (OR 0.56, 95%CI 0.39-0.79) was independently associated with lack of aspirin use in this population. Independent determinants of aspirin use included annual income of $50,000 or more (OR 1.59, 95%CI: 1.03-2.45) and having taken a diabetic education class (OR 1.47, 95% CI: 1.10-1.96).
Conclusions: Financial barriers to medical care are independently associated with poorer rates of aspirin use in diabetic patients with coronary artery disease.
- © 2010 by American Heart Association, Inc.