Sex-related disparities in perception of health status, access to healthcare, and health literacy among patients with heart failure in the NIH all of us research program

Background Despite ongoing advancements in heart failure care, sex-related disparities continue to be a major challenge in healthcare. Objectives We aimed to describe sex-related differences in self-reported perceived health status, healthcare access, and health-literacy-related items among All of Us participants with an EHR-recorded diagnosis of heart failure. Design Cross-sectional secondary analysis of the National Institutes of Health (NIH) All of Us Research Program. Methods This cross-sectional secondary analysis used linked EHR and survey data from the NIH All of Us Research Program. Survey responses were used to describe sociodemographic characteristics, self-perceived health status, health-literacy-related items, and healthcare access among participants with an EHR-recorded diagnosis of heart failure. Participants were grouped according to self-reported sex assigned at birth. Analyses were descriptive and unadjusted; item-specific denominators were used because survey completion varied across modules and questions. Results The cohort included 28,465 participants, comprising 14,496 females and 13,969 males. Female participants more frequently reported lower educational attainment, unemployment, lower annual income, and non-homeownership. The distributions of general, physical, and mental health, quality of life, functional limitations, fatigue, emotional problems, social satisfaction, and pain differed between female and male respondents. Female respondents also more frequently reported several financial and transportation-related barriers to care, including delayed care because of transportation or costs and inability to afford medications or clinical care. Responses to the three health-literacy-related items also differed by sex, with female respondents more frequently reporting no need for assistance with health materials, greater confidence completing medical forms, and no difficulty understanding health information. These findings represent unadjusted descriptive differences and should not be interpreted as independent effects of sex. Conclusion Among All of Us participants with an EHR-recorded diagnosis of heart failure, female and male respondents differed across several self-reported measures of socioeconomic circumstances, perceived health and quality of life, healthcare access, and health-literacy-related items.