Stroke survivors less than 65 years old report having more difficulty accessing physicians and affording medications than stroke survivors older than 65, according to an article posted online today that will appear in the January 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Approximately 5.4 million U.S. adults have survived a stroke, according to background information in the article. These individuals require comprehensive care to modify their risk factors for heart disease and prevent secondary strokes; the risk for recurrent strokes ranges from 5 percent to 15 percent each year. Additional strokes and other cardiovascular events, such as heart attack, in stroke survivors increase their rates of illness and death as well as their health care costs. Stroke survivors younger than age 65 may typically do not qualify for Medicare health insurance and are more likely to be uninsured than older stroke survivors.
Deborah A. Levine, M.D., M.P.H. Birmingham Veterans Affairs Medical Center and University of Alabama at Birmingham, and colleagues assessed access to care among stroke survivors age 45 years and older who responded between 1998 and 2002 to the National Health Interview Survey, an annual government-conducted survey. Respondents answered questions about whether they had ever been diagnosed with stroke, if they had seen or talked to a general physician or specialist in the past 12 months, and whether they needed prescription medications in the past year but could not afford them.
Of the 3,681 total stroke survivors interviewed, 2,509 were age 65 and older (average age 76) and 1,172 were age 45 to 64 (average age 56). Compared with older stroke survivors, younger stroke survivors were more likely to be black (19 percent vs. 10 percent), male (52 percent vs. 47 percent) and to not have health insurance (11 percent vs. .4 percent).
They also were more likely to report not visiting a general physician (14 percent vs. 10 percent), not visiting a general physician or medical specialist (8 percent vs. 5 percent) and the inability to afford medications (15 percent vs. 6 percent). "Lack of health insurance explained some of the reduced access to physician care among younger stroke survivors but not their more frequent problems with medication affordability," the authors write.
Because treatments to prevent second strokes often include drugs to reduce blood pressure and cholesterol and are usually administered by a primary care physician, younger stroke survivors may be at higher risk for recurrence. "Further research is needed to determine whether this younger high-risk population has adverse outcomes, such as death and cardiovascular events, or has increased long-term health care utilization due to reduced access to physician care and medications," the authors conclude. "Further work addressing access gaps, linking to related health outcomes and costs and demonstrating the effectiveness and cost-effectiveness of possible improvement strategies is warranted."
(Arch Neurol. 2007;64:(doi:10.1001/archneur.64.1.noc60002). Available pre-embargo to the media at www.jamamedia.org.)
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