Table 3.
Exploratory analysis examining combinations of barriers to healthcare access and 2-year all-cause mortality following hospital discharge for an acute coronary syndrome
| Barriers to healthcare access | Proportion of overall sample, n (%) | Two-year mortality, n (%) | Crude hazard ratio (95% CI) | Adjusted hazard ratio* (95% CI) |
|---|---|---|---|---|
| No healthcare barriers present | 1090 (54.3) | 53 (4.9) | Referent | Referent |
| 1 Barrier present | ||||
| Financial barrier only | 396 (19.7) | 12 (3.0) | 0.61 (0.30, 1.26) | 0.73 (0.41, 1.30) |
| No usual source of care only | 160 (8.0) | 7 (4.4) | 0.90 (0.80, 1.00) | 0.92 (0.75, 1.13) |
| Transportation barrier only | 77 (3.8) | 9 (11.7) | 2.47 (1.06, 5.75) | 1.80 (0.78, 4.17) |
| 2 Barriers present | ||||
| Financial barrier and no usual source of care | 123 (6.1) | 8 (6.5) | 1.37 (0.58, 3.24) | 1.89 (1.10, 3.26) |
| Financial barrier and transportation barrier | 102 (5.1) | 4 (3.9) | 0.84 (0.28, 2.46) | 0.71 (0.35, 1.45) |
| No usual source of care and transportation barrier | 16 (0.8) | 2 (12.5) | 2.66 (0.66, 10.73) | 2.61 (0.89, 7.70) |
| All 3 healthcare barriers present | 44 (2.2) | 5 (11.4) | 2.38 (2.02, 2.81) | 1.43 (1.19, 1.72) |
Adjusted for: site, sex, race/ethnicity, GRACE risk score (incorporates data on age, cardiac biomarkers, ST segment changes, systolic blood pressure, creatinine level or history of renal dysfunction, Killip class or use of diuretics, development of cardiac arrest during the index hospitalization), education, living situation, ACS type, hospital receipt of reperfusion therapy, prior heart disease, prior peripheral vascular disease, prior diabetes, depressive symptoms, hospital discharge use of ACE/ARBs, aspirin, beta blockers, lipid-lowering agents, and dual antiplatelet therapy