Abstract 1947: Hispanics are Half As Likely As Others to Use EMS and Experience a Favorable 3-Month Outcome after Acute Ischemic Stroke in San Diego, California
Background: Bridging racial-ethnic disparities in health care is a top public health priority. Hispanic Americans, the fastest growing segment in the United States, are at significantly higher risk of stroke than Non-Hispanic Whites, but may be less likely to use emergency medical services (EMS) in the event of an acute stroke. We compared pre-hospital/emergency department (ED) processes of care and 3-month outcomes by ethnicity in acute ischemic stroke (AIS) patients encountered in urban setting.
Methods: Our University Stroke Program provides acute stroke care to five hospitals in San Diego that serve persons of varying race-ethnic and socioeconomic backgrounds. Socio-demographic, clinical, discharge and day-90 data on AIS patients presenting within 12 hours of ictus are prospectively collected in a database. For this study, specific variables of interest included use of EMS, time of stroke onset, time of arrival to the ED, and time of treatment decision and day-90 modified Rankin Scale (mRS) score. Wilcoxon Rank-Sum test was used for comparisons of continuous variables and Fisher’s Exact test was used for categorical variables. Favorable outcome was defined as day-90 modified Rankin Scale (mRS) score of 0-1. Outcome was adjusted for pre-specified covariates in a multivariable regression model.
Results: There were 192 Hispanic and 925 non-Hispanic AIS patients encountered from June 2004 to March 2011. Hispanic patient differed from Non-Hispanic patients in mean age (65.6 vs. 70.9 years, p<0.01), female gender (57.8% vs. 44%, p<0.0001), and diabetes (37.5% vs. 20%, p <0.0001). Hispanic patients arrived by ambulance (vs. other arrival modes) less frequently (73.4% vs. 83.0%, OR 0.56; 95% CI: 0.38 - 0.81, p=0.003). There was no difference in time of stroke onset to arrival (252.7 vs. 279.5 p = 0.4) or treatment decision (351.6 vs. 320.02 minutes, p = 0.07). Favorable day-90 outcome was seen in 28.57% of Hispanic vs. 40.14% of Non-Hispanic AIS patients (OR 0.52, CI 0.28-0.96, p=0.04).
Discussion: Individuals of Hispanic ethnicity in San Diego have about half the odds of a favorable outcome after acute ischemic stroke compared to others. Lack of EMS use by Hispanics is likely a major contributing factor. Development of strategies to boost EMS utilization may mitigate this worrisome stroke outcome disparity.
- © 2012 by American Heart Association, Inc.