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.
Abstract
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.
Type
Journal articleSubject
HumansTransportation of Patients
Hospitalization
Registries
Multivariate Analysis
Logistic Models
Odds Ratio
Chi-Square Distribution
Health Knowledge, Attitudes, Practice
Sex Factors
Aged
Middle Aged
African Americans
Asian Americans
European Continental Ancestry Group
Hispanic Americans
Emergency Medical Services
Patient Acceptance of Health Care
United States
Female
Male
Stroke
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https://hdl.handle.net/10161/21833Published Version (Please cite this version)
10.1161/jaha.115.002099Publication Info
Mochari-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.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Ying Xian
Adjunct Associate Professor in the Department of Neurology

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