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.

Mochari-Greenberger, Heidi

Xian, Ying

Hellkamp, Anne S

Schulte, Phillip J

Bhatt, Deepak L

Fonarow, Gregg C

Saver, Jeffrey L

Reeves, Mathew J

Schwamm, Lee H

Smith, Eric E

2020-12-04T18:11:57Z

2020-12-04T18:11:57Z

2015-08-12

2020-12-04T18:11:55Z

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.

JAHA.115.002099

2047-9980

2047-9980

https://hdl.handle.net/10161/21833

eng

Ovid Technologies (Wolters Kluwer Health)

Journal of the American Heart Association

10.1161/jaha.115.002099

Humans

Transportation 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

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 article

Xian, Ying|0000-0002-1237-1162

e002099

8

School of Medicine

Duke Clinical Research Institute

Neurology, Neurocritical Care

Medicine, Clinical Pharmacology

Duke

Institutes and Centers

Neurology

Clinical Science Departments

Medicine

Duke Innovation & Entrepreneurship

Medicine, Cardiology

Initiatives

Institutes and Provost's Academic Units

Published

4