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Cited by 89Sex and Gender in HealthcareHealth disparities and outcomesHealthcare Policy and Management

Gender disparities in difficulty accessing healthcare and cost-related medication non-adherence: The CDC behavioral risk factor surveillance system (BRFSS) survey

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Daher, Marilyne, Al Rifai, Mahmoud, Kherallah, Riyad Y., Rodriguez, Fatima, Mahtta, Dhruv, Michos, Erin D., Khan, Safi U., Petersen, Laura A. +1 more·2021·Preventive Medicine
DOI 10.1016/j.ypmed.2021.106779PMC PMC9291436
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Abstract

Ensuring healthcare access is critical to maintain health and prevent illness. Studies demonstrate gender disparities in healthcare access. Less is known about how these vary with age, race/ethnicity, and atherosclerotic cardiovascular disease. We utilized cross-sectional data from 2016 to 2019 CDC Behavioral Risk Factor Surveillance System (BRFSS), a U.S. telephone-based survey of adults (≥18 years). Measures of difficulty accessing healthcare included absence of healthcare coverage, delay in healthcare access, absence of primary care physician, >1-year since last checkup, inability to see doctor due to cost, and cost-related medication non-adherence. We studied the association between gender and these variables using multivariable-adjusted logistic regression models, stratifying by age, race/ethnicity, and atherosclerotic cardiovascular disease status. Our population consisted of 1,737,397 individuals; 54% were older (≥45 years), 51% women, 63% non-Hispanic White, 12% non-Hispanic Black,17% Hispanic, 9% reported atherosclerotic cardiovascular disease. In multivariable-adjusted models, women were more likely to report delay in healthcare access: odds ratio (OR) and (95% confidence interval): 1.26 (1.11, 1.43) [p < 0.001], inability to see doctor due to cost: 1.29 (1.22, 1.36) [p < 0.001], cost-related medication non-adherence: 1.24 (1.01, 1.50) [p = 0.04]. Women were less likely to report lack of healthcare coverage: 0.71 (0.66, 0.75) [p < 0.001] and not having a primary care physician: 0.50 (0.48, 0.52) [p < 0.001]. Disparities were pronounced in younger (<45 years) and Black women. Identifying these barriers, particularly among younger women and Black women, is crucial to ensure equitable healthcare access to all individuals.

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  • The higher mortality rates in females may reflect gender-based differences in access to healthcare facilities in the United States.

    “The higher mortality rates in females may reflect gender‐based differences in access to healthcare facilities in the United States [16].”

    From Trends and Demographics of Vascular Intestinal Diseases‐Related Mortality Among Adults Living in United States From 1999 to 2020; A CDC Wonder Analysis (2025) · cites this paper as [16]

    The Results report that U.S. women were more likely than men to report delays in healthcare access and inability to see a doctor because of cost. The paper does not assess whether these differences explain higher female mortality; the Discussion says ASCVD mortality rates are similar among men and women and notes that the cross-sectional analysis cannot establish causality. (LLM, conf=0.85)

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Authors
Daher, M., Al Rifai, M., Kherallah, R. Y., Rodriguez, F., Mahtta, D., Michos, E. D., Khan, S. U., Petersen, L. A., & Virani, S. S.
Affiliations
  • Baylor College of Medicine (US)
  • Johns Hopkins University (US)
  • West Virginia University (US)
  • Michael E. DeBakey VA Medical Center (US)
Corresponding author
Virani, Salim S.
ORCID
Venue
Preventive Medicine
Publisher
Elsevier BV
Published
2021-12
Volume
153
Pages
106779
ISSN
0091-7435 (ISSN-L)
DOI
10.1016/j.ypmed.2021.106779
PMC
PMC9291436
OpenAlex
W3196885724
Cited by
89
References
39
Citations by year
2026: 38 · 2025: 32 · 2024: 12 · 2023: 4 · 2022: 2 · 2021: 1
FWCI
4.12
Type
journal article
Language
en
Open access
Licence
Locations
  • Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eCommons - AKU (Aga Khan University) (submittedVersion, cc-by-nc-nd)
Funders
National Heart, Lung, and Blood Institute (K01HL144607)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Sex and Gender in Healthcare
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
gender disparities, health care access, lack of health insurance, atherosclerotic cardiovascular disease, Black women, young women, racial and ethnic disparities, health equity
MeSH terms
Adult, Centers for Disease Control and Prevention, U.S., Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Male, United States, Behavioral Risk Factor Surveillance System, Healthcare Disparities, Medication Adherence

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