Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry.
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Differences in activation of emergency medical services (EMS) may contribute to racial/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity and sex among a current, diverse national sample of hospitalized acute stroke patients.We analyzed data from 398,798 stroke patients admitted to 1613 Get With The Guidelines-Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial/ethnic and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. Patients were 50% female, 69% white, 19% black, 8% Hispanic, 3% Asian, and 1% other, and 86% had ischemic stroke. Overall, 59% of stroke patients were transported to the hospital by EMS. White women were most likely to use EMS (62%); Hispanic men were least likely to use EMS (52%). After adjustment for patient characteristics, Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS versus their white counterparts; black women were less likely than white women to use EMS (odds ratio 0.75, 95% CI 0.72 to 0.77). Patients with weakness or paresis, altered level of consciousness, and/or aphasia were significantly more likely to use EMS than patients without each symptom; the observed racial/ethnic and sex differences in EMS use remained significant after adjustment for stroke symptoms.EMS use differed by race/ethnicity and sex. These contemporary data document suboptimal use of EMS transport among US stroke patients, especially by racial/ethnic minorities and those with less recognized stroke symptoms.
Transportation of Patients
Health Knowledge, Attitudes, Practice
European Continental Ancestry Group
Emergency Medical Services
Patient Acceptance of Health Care
Published Version (Please cite this version)10.1161/jaha.115.002099
Publication InfoMochari-Greenberger, Heidi; Xian, Ying; Hellkamp, Anne S; Schulte, Phillip J; Bhatt, Deepak L; Fonarow, Gregg C; ... Smith, Eric E (2015). Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry. Journal of the American Heart Association, 4(8). pp. e002099. 10.1161/jaha.115.002099. Retrieved from https://hdl.handle.net/10161/21833.
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Associate Professor in Neurology
Dr. Xian is an Associate Professor of Neurology and Medicine at the Duke University Medical Center and Duke Clinical Research Institute. He received his Medical Degree from Beijing Medical University (Peking University Health Science Center) and completed an Internal Medicine Residency and Cardiology Fellowship at Peking University People’s Hospital, and Fuwai Hospital, Peking Union Medical College. Dr. Xian’s research is dedicated to improving health care quality and outcomes in