2021
Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018
Mahajan S, Caraballo C, Lu Y, Valero-Elizondo J, Massey D, Annapureddy AR, Roy B, Riley C, Murugiah K, Onuma O, Nunez-Smith M, Forman HP, Nasir K, Herrin J, Krumholz HM. Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999-2018. JAMA 2021, 326: 637-648. PMID: 34402830, PMCID: PMC8371573, DOI: 10.1001/jama.2021.9907.Peer-Reviewed Original ResearchConceptsHealth care accessFair health statusSelf-reported health statusCare accessHealth statusWhite individualsEthnic differencesLatino/HispanicNational Health Interview Survey dataSerial cross-sectional studySelf-reported functional limitationsBlack individualsHealth Interview Survey dataLow incomeCross-sectional studyCross-sectional survey studyInterview Survey dataSelf-reported raceSelf-report measuresMAIN OUTCOMEUS adultsFunctional limitationsPercentage of peopleSignificant decreaseAdultsOut‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States
Wang SY, Valero‐Elizondo J, Ali H, Pandey A, Cainzos‐Achirica M, Krumholz HM, Nasir K, Khera R. Out‐of‐pocket Annual Health Expenditures and Financial Toxicity from Healthcare Costs in Patients with Heart Failure in the United States. Journal Of The American Heart Association 2021, 10: e022164. PMID: 33998273, PMCID: PMC8483501, DOI: 10.1161/jaha.121.022164.Peer-Reviewed Original ResearchConceptsGreater risk-adjusted oddsRisk-adjusted oddsHeart failureMedical Expenditure Panel SurveyCatastrophic financial burdenPocket healthcare expensesHigh financial burdenFinancial toxicityHealthcare expensesFinancial burdenHealthcare costsCatastrophic burdenMajor public health burdenLow-income familiesBackground Heart failurePublic health burdenInsurance premiumsPanel SurveyPocket healthcare costsAnnual health expenditureWorld Health OrganizationConclusions PatientsHealth insurance premiumsPocket healthcare expenditureHealth burden
2020
Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults
Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan SU, Cainzos-Achirica M, Vahidy FS, Krumholz HM, Nasir K. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke 2020, 51: 3552-3561. PMID: 33100188, DOI: 10.1161/strokeaha.120.031137.Peer-Reviewed Original ResearchConceptsNational Health Interview SurveyCommon stroke symptomsStroke symptomsHealth Interview SurveyYoung adultsUS young adultsSymptom awarenessFocused public health interventionsInterview SurveyStroke symptom awarenessHigh-risk characteristicsPublic health interventionsArms/legsCertain sociodemographic subgroupsLow education levelStroke incidenceSevere headacheSingle symptomStudy populationTimely diagnosisHigher oddsStroke rateHispanic ethnicityGeneral populationSociodemographic determinantsStroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic
Jasne AS, Chojecka P, Maran I, Mageid R, Eldokmak M, Zhang Q, Nystrom K, Vlieks K, Askenase M, Petersen N, Falcone GJ, Wira CR, Lleva P, Zeevi N, Narula R, Amin H, Navaratnam D, Loomis C, Hwang DY, Schindler J, Hebert R, Matouk C, Krumholz HM, Spudich S, Sheth KN, Sansing LH, Sharma R. Stroke Code Presentations, Interventions, and Outcomes Before and During the COVID-19 Pandemic. Stroke 2020, 51: 2664-2673. PMID: 32755347, PMCID: PMC7446978, DOI: 10.1161/str.0000000000000347.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overBetacoronavirusBrain IschemiaCohort StudiesComorbidityConnecticutCoronary Artery DiseaseCoronavirus InfectionsCOVID-19DyslipidemiasEmergency Medical ServicesEthnicityFemaleHumansHypertensionIncomeInsurance, HealthIntracranial HemorrhagesMaleMedically UninsuredMiddle AgedOutcome and Process Assessment, Health CarePandemicsPneumonia, ViralRetrospective StudiesSARS-CoV-2Severity of Illness IndexStrokeSubstance-Related DisordersTelemedicineThrombectomyThrombolytic TherapyTime-to-TreatmentConceptsComprehensive stroke centerStroke codePatient characteristicsStroke severityStroke code patientsHistory of hypertensionStroke-like symptomsCoronary artery diseaseCoronavirus disease 2019 (COVID-19) pandemicPatient-level dataLower median household incomePublic health initiativesDisease 2019 pandemicCOVID-19 pandemicRace/ethnicityCode patientsHospital presentationPublic health insuranceRankin ScaleStroke centersArtery diseaseReperfusion timeStroke symptomsEarly outcomesConnecticut hospitalsBurden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States
Caraballo C, Valero-Elizondo J, Khera R, Mahajan S, Grandhi GR, Virani SS, Mszar R, Krumholz HM, Nasir K. Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States. Circulation Cardiovascular Quality And Outcomes 2020, 13: e006139. PMID: 32069093, DOI: 10.1161/circoutcomes.119.006139.Peer-Reviewed Original ResearchMeSH KeywordsAdolescentAdultAge FactorsBlack or African AmericanComorbidityCost of IllnessCross-Sectional StudiesDiabetes MellitusFemaleFinancing, PersonalFood SupplyHealth Care CostsHealth Care SurveysHealth ExpendituresHealth Services AccessibilityHumansIncomeMaleMedically UninsuredMiddle AgedPatient ComplianceRisk AssessmentRisk FactorsUnited StatesYoung AdultConceptsDiabetes mellitusMedical billsHigher oddsMedical careNational Health Interview Survey dataHealth Interview Survey dataCost-related medication nonadherenceHigher comorbidity burdenCost-related nonadherenceSelf-reported diagnosisNon-Hispanic blacksInterview Survey dataFinancial hardshipMedication nonadherenceMean ageNonmedical needsHigh prevalenceMellitusMultivariate analysisPocket expenditureFood insecurityNonadherenceHigh financial distressPatientsAdults
2019
Association of Income Disparities with Patient-Reported Healthcare Experience
Okunrintemi V, Khera R, Spatz ES, Salami JA, Valero-Elizondo J, Warraich HJ, Virani SS, Blankstein R, Blaha MJ, Pawlik TM, Dharmarajan K, Krumholz HM, Nasir K. Association of Income Disparities with Patient-Reported Healthcare Experience. Journal Of General Internal Medicine 2019, 34: 884-892. PMID: 30783877, PMCID: PMC6544715, DOI: 10.1007/s11606-019-04848-4.Peer-Reviewed Original ResearchConceptsPatient healthcare experienceHealthcare experiencesHigher oddsMedical Expenditure Panel Survey cohortHealthcare providersRepresentative US adult populationUS adult populationTimes higher oddsQuality of careTimes greater oddsLow incomePoor healthcare experiencesRetrospective studyPatient incomePatient levelPatient reportsUS adultsProvider satisfactionGreater oddsPatientsHealth outcomesSurvey cohortAdult populationStudy participantsAspects of access
2018
Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States
Khera R, Valero-Elizondo J, Okunrintemi V, Saxena A, Das SR, de Lemos JA, Krumholz HM, Nasir K. Association of Out-of-Pocket Annual Health Expenditures With Financial Hardship in Low-Income Adults With Atherosclerotic Cardiovascular Disease in the United States. JAMA Cardiology 2018, 3: 729-738. PMID: 29971325, PMCID: PMC6143078, DOI: 10.1001/jamacardio.2018.1813.Peer-Reviewed Original ResearchConceptsCatastrophic financial burdenLow-income familiesPocket health care expensesHigh financial burdenMedical Expenditure Panel SurveyHealth care expensesFamily incomeFinancial burdenPanel SurveyHealth expensesMean annual family incomePocket expensesCare expensesFinancial hardshipAtherosclerotic cardiovascular diseaseLow incomePocket health expensesAssociation of OutAnnual family incomeFederal poverty limitHigh-income familiesAnnual health expenditureLow-income adultsInsurance premiumsHealth expenditureTime to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study
Guan W, Venkatesh AK, Bai X, Xuan S, Li J, Li X, Zhang H, Zheng X, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study. European Heart Journal - Quality Of Care And Clinical Outcomes 2018, 5: 63-71. PMID: 29878087, PMCID: PMC6307335, DOI: 10.1093/ehjqcco/qcy022.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHospital arrivalSymptom onsetMyocardial infarctionMedical insuranceLower household incomeRural medical insuranceChest discomfortChest painIndex hospitalizationMedian timeMultivariable analysisAMI symptomsProspective studyAssociated FactorsPatients' perceptionsCare seekingAMI hospitalizationPatientsSymptomsHousehold incomeAMI studyHospitalizationInfarctionAverage time
2017
Burden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States
Khera R, Hong JC, Saxena A, Arrieta A, Virani SS, Blankstein R, de Lemos JA, Krumholz HM, Nasir K. Burden of Catastrophic Health Expenditures for Acute Myocardial Infarction and Stroke Among Uninsured in the United States. Circulation 2017, 137: 408-410. PMID: 29133601, PMCID: PMC5780190, DOI: 10.1161/circulationaha.117.030128.Commentaries, Editorials and LettersMeSH KeywordsAdolescentAdultFemaleHealth Care CostsHealth ExpendituresHealth Services AccessibilityHospital ChargesHospital CostsHumansIncomeMaleMedically UninsuredMiddle AgedMyocardial InfarctionPatient Protection and Affordable Care ActProcess Assessment, Health CareStrokeTime FactorsUnited StatesYoung Adult
2016
Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction
Beckman AL, Bucholz EM, Zhang W, Xu X, Dreyer RP, Strait KM, Spertus JA, Krumholz HM, Spatz ES. Sex Differences in Financial Barriers and the Relationship to Recovery After Acute Myocardial Infarction. Journal Of The American Heart Association 2016, 5: e003923. PMID: 27742618, PMCID: PMC5121496, DOI: 10.1161/jaha.116.003923.Peer-Reviewed Original ResearchMeSH KeywordsAdultAftercareDepressionDrug CostsFemaleHealth Services AccessibilityHumansIncomeLinear ModelsMaleMedication AdherenceMiddle AgedMultivariate AnalysisMyocardial InfarctionPatient Health QuestionnaireProspective StudiesRecovery of FunctionSex FactorsSocioeconomic FactorsSpainUnited StatesConceptsAcute myocardial infarctionMyocardial infarctionFinancial barriersHealth status 12 monthsYoung adultsPost-AMI outcomesYear post-AMIYoung AMI patientsMultivariable linear regression modelsGreater depressive symptomatologyMental functional statusSex differencesClinical characteristicsYounger patientsAMI patientsPost-AMIFunctional statusWorse outcomesBaseline healthPsychosocial statusOutcomes 1Depressive symptomatologyPatientsMore womenHealth careGeographic Variation in Trends and Disparities in Acute Myocardial Infarction Hospitalization and Mortality by Income Levels, 1999-2013
Spatz ES, Beckman AL, Wang Y, Desai NR, Krumholz HM. Geographic Variation in Trends and Disparities in Acute Myocardial Infarction Hospitalization and Mortality by Income Levels, 1999-2013. JAMA Cardiology 2016, 1: 255-65. PMID: 27438103, PMCID: PMC5459393, DOI: 10.1001/jamacardio.2016.0382.Peer-Reviewed Original Research
2015
Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction
Bucholz EM, Ma S, Normand SL, Krumholz HM. Race, Socioeconomic Status, and Life Expectancy After Acute Myocardial Infarction. Circulation 2015, 132: 1338-1346. PMID: 26369354, PMCID: PMC5097251, DOI: 10.1161/circulationaha.115.017009.Peer-Reviewed Original ResearchTrends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study
Zhan L, Masoudi FA, Li X, Hu S, Venkatesh AK, Spertus JA, Lin Z, Desai NR, Li J, Krumholz HM, Jiang L, . Trends in Cardiac Biomarker Testing in China for Patients with Acute Myocardial Infarction, 2001 to 2011: China PEACE-Retrospective AMI Study. PLOS ONE 2015, 10: e0122237. PMID: 25893247, PMCID: PMC4404305, DOI: 10.1371/journal.pone.0122237.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionCardiac biomarker testingProportion of hospitalsBiomarker testingChinese hospitalsDiagnosis of AMIChina PEACE-Retrospective AMI StudyRate of useMiddle-income countriesMyocardial infarctionPractice compliesHigh-income countriesAMI admissionsBiomarker testsUrban hospitalBiomarker use
2014
Place of Residence and Outcomes of Patients With Heart Failure
Bikdeli B, Wayda B, Bao H, Ross JS, Xu X, Chaudhry SI, Spertus JA, Bernheim SM, Lindenauer PK, Krumholz HM. Place of Residence and Outcomes of Patients With Heart Failure. Circulation Cardiovascular Quality And Outcomes 2014, 7: 749-756. PMID: 25074375, PMCID: PMC5323058, DOI: 10.1161/circoutcomes.113.000911.Peer-Reviewed Original ResearchConceptsNeighborhood socioeconomic statusIndividual socioeconomic statusOutcomes of patientsHeart failureHigher SES neighborhoodsSocioeconomic statusClinical factorsHeart Failure Outcomes trialPrimary end pointPatient-level factorsUS internal medicineCause mortalityCause readmissionMultivariable adjustmentOutcome trialsMedical chartsPatient interviewsLow-SES neighborhoodsCardiology practiceMortality ratePatientsPlace of residenceInternal medicineReadmissionEnd point
2012
Financial Stress and Outcomes after Acute Myocardial Infarction
Shah SJ, Krumholz HM, Reid KJ, Rathore SS, Mandawat A, Spertus JA, Ross JS. Financial Stress and Outcomes after Acute Myocardial Infarction. PLOS ONE 2012, 7: e47420. PMID: 23112814, PMCID: PMC3480393, DOI: 10.1371/journal.pone.0047420.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionSeattle Angina QuestionnaireLong-term outcomesMyocardial infarctionAMI patientsWorse long-term outcomesMulticenter US studyPost-AMI outcomesYear post-AMIDisease-specific QoLImportant risk factorHealth status outcomesWorse physical healthHealth care outcomesAngina QuestionnaireProspective registryInitial hospitalizationSecondary outcomesPrimary outcomeReadmission ratesPost-AMIRisk factorsCare characteristicsCare outcomesStatus outcomes
2011
Gender Differences in Presentation, Management, and In-Hospital Outcomes for Patients with AMI in a Lower-Middle Income Country: Evidence from Egypt
Butala NM, Desai MM, Linnander EL, Wong YR, Mikhail DG, Ott LS, Spertus JA, Bradley EH, Aaty AA, Abdelfattah A, Gamal A, Kholeif H, Baz M, Allam AH, Krumholz HM. Gender Differences in Presentation, Management, and In-Hospital Outcomes for Patients with AMI in a Lower-Middle Income Country: Evidence from Egypt. PLOS ONE 2011, 6: e25904. PMID: 22022463, PMCID: PMC3192760, DOI: 10.1371/journal.pone.0025904.Peer-Reviewed Original ResearchConceptsAcute myocardial infarctionHospital outcomesFemale patientsInitial presentationClinical managementDiagnosis of AMIIncome countriesIn-Hospital OutcomesOutcomes of patientsTime of presentationMultivariate logistic regressionGender differencesQuality of careLow-middle income countriesHospital mortalityHospital deathDiabetes mellitusHeart failureAtrial fibrillationHigher BMIMyocardial infarctionCardiovascular diseaseRegistry dataHigh-income countriesEgyptian hospitals
2002
Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans
Vaccarino V, Gahbauer E, Kasl SV, Charpentier PA, Acampora D, Krumholz HM. Differences between African Americans and whites in the outcome of heart failure: Evidence for a greater functional decline in African Americans. American Heart Journal 2002, 143: 1058-1067. PMID: 12075264, DOI: 10.1067/mhj.2002.122123.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAnalysis of VarianceBlack PeopleCohort StudiesFemaleHealth Services AccessibilityHeart FailureHospitalizationHumansIncomeMaleMiddle AgedOutcome Assessment, Health CareProportional Hazards ModelsProspective StudiesQuality of Health CareSocioeconomic FactorsWhite PeopleConceptsGreater functional declineHeart failureCare indicatorsFunctional declineAfrican AmericansSelf-reported health statusSigns of decompensationDecompensated heart failureHistory of hypertensionProspective cohort studyVentricular ejection fractionDaily living functionAfrican American patientsDaily living functioningRenal insufficiencyBaseline characteristicsCohort studyConsecutive patientsEjection fractionHospital admissionFunctional statusAmerican patientsPoor courseLiving functioningHigh risk