Date of Award

January 2016

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Mayur M. Desai


Introduction: Hypertension, high cholesterol, diabetes, obesity, and smoking are established risk factors for cardiovascular disease (CVD), and the presence of several risk factors is associated with worse health outcomes. Access to healthcare has a major influence on the management and treatment of these modifiable conditions. The objective of this study is to examine barriers to care among non-elderly adults with multiple risk factors for CVD, and to furthermore identify socio-demographic disparities within this group.

Methods: Analyses utilized data from a subset of 39 U.S. states and territories that implemented the optional healthcare access module in the 2013 Behavioral Risk Factor Surveillance System (BRFSS) survey. A sample of non-elderly adults (18–64 years) with three or more risk factors for CVD was used to estimate barriers to care, which included not having insurance, not having a regular provider, not receiving a checkup within two years, not seeing a doctor due to cost, and not taking medications as prescribed due to cost. Descriptive analysis and logistic regression were conducted.

Results: From a sample of 216,961 eligible respondents, 12.5% had three or more risk factors. Among this subset, 22.9% lacked insurance, 20.1% did not have a regular provider, 14.6% did not have a checkup within two years, 28.9% were unable to visit a provider due to cost, and 25.8% reported not taking medications as prescribed due to cost. Cost-related barriers were even greater among a sub-group with history of cardiovascular conditions. Assessment of socio-demographic characteristics revealed that respondents in the younger age group were more likely to experience all barriers to care. Cost-related barriers in particular were more common among females and low-income individuals, while the access-related barriers occurred more frequently among males, certain race/ethnicity groups, and those with low education.

Conclusion: Barriers to care are widespread among non-elderly adults with multiple risk factors for CVD, and financial barriers are most likely to affect those who are young, female, and low-income.


This thesis is restricted to Yale network users only. It will be made publicly available on 06/07/2018