Introduction: Premature atherosclerotic cardiovascular disease (ASCVD) is a growing public health concern, particularly among women and socioeconomically vulnerable adults. Data on sex differences in healthcare access and psychosocial well-being in this population remain limited. Hypothesis: We hypothesized that women with premature ASCVD experience greater psychosocial burden and barriers to healthcare access compared with men, independent of socioeconomic and clinical characteristics. Methods: We analyzed pooled Behavioral Risk Factor Surveillance System (BRFSS) data from 2020–2023 using survey design–based methods. ASCVD was defined by self-reported myocardial infarction, coronary heart disease, or stroke; premature ASCVD as onset before age 55 years. Psychosocial burden was assessed using three validated BRFSS indicators: diagnosed depression, poor self-rated health, and low emotional support. Access outcomes included lack of insurance and cost-related care barriers. All estimates incorporated sampling weights, strata, and primary sampling units. Sex-based differences were evaluated with design-adjusted chi-square tests, and multivariable survey-weighted logistic regressions estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs) controlling for age, race/ethnicity, income, education, diabetes, hypertension, and physical activity. Results: Among 1,632,884 respondents (representing ≈245 million U.S. adults), 10.4% reported ASCVD (≈28 million), and 23.7% had premature onset (<55 years; ≈6.7 million). In the overall ASCVD cohort, women had higher odds of depression (OR 1.93, 95% CI 1.83–2.04), fair/poor health (OR 1.29, 1.23–1.36), and cost barriers (OR 1.18, 1.09–1.28) but lower odds of lacking emotional support (OR 0.77, 0.60–0.99). Uninsurance rates were similar (6.2%). In premature ASCVD, disparities were most pronounced: nearly half of women (49.3%) reported depression versus one-third of men (34.3%) (OR 1.87, 1.66–2.10), and women remained more likely to report poor self-rated health (OR 1.25, 1.11–1.41). Conclusions: Nearly one in four adults with ASCVD develop the disease prematurely, representing over 6 million Americans, roughly half of whom are women. Despite similar insurance coverage, women with premature ASCVD experience greater psychosocial burden, driven by higher depression and poorer self-perceived health. Integrating behavioral health screening and reducing cost barriers are essential to achieving cardiovascular health equity.
Dalal et al. (Tue,) studied this question.