Abstract 3650: Community Poverty and Pre-Hospital Delay in Acute Ischemic Stroke
Introduction Many factors contribute to pre-hospital delays for ischemic stroke patients, including knowledge of stroke warning signs and risk factors. However, the direct association of community poverty with pre-hospital delay is unknown. We present data regarding the association of community socioeconomic status (C-SES) with pre-hospital delay after acute ischemic stroke in 2005 within a large, biracial, economically diverse population.
Methods Hospitalized cases of AIS were ascertained as part of the Greater Cincinnati / Northern Kentucky Stroke Study; cases were only included if they lived at home, had their stroke at home, and presented to an ED. C-SES was defined as the proportion of residents within the patients' census tract of residence who fell below the federal poverty line (2000 US Census). Pre-hospital delay time (DT) was calculated using ED arrival time and time of symptom onset, categorized into <3hrs, 3-12 hrs, 12-24 hrs, and >24 hrs. Patients were grouped into quartiles according to their C-SES (less than 5%, 5% to 10%, 10 to 25%, and greater than 25%). Estimated travel time was calculated using Arcview software.
Results There were 2196 hospitalized cases of acute ischemic stroke recorded in 2005, 1453 of which occurred at home, 1377 of which reported to local ED's. Of these, 434 reported an exact time of symptom onset, but an estimated time of onset was available for 915 cases. C-SES was not significantly associated with DT. The proportion arriving in less than three hours, which was >25% poverty: 17%, 10%-25% poverty: 22%, 5%-10% poverty: 22%, <5% poverty 21%, was also not associated with C-SES. See table for odds ratios for earlier arrival to the ED. EMS use was strongly associated with earlier arrival time (p < .01).
Discussion Greater community poverty was not associated with the percentage of patients arriving within the rt-PA eligibility window. EMS was strongly associated with shorter delay times. Further study is needed to inform educational efforts toward improving pre-hospital delays.
- © 2012 by American Heart Association, Inc.