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Socioeconomic disparities in prehospital stroke care

Journal article
Authors Amanda Niklasson
J. Herlitz
Katarina Jood
Published in Scandinavian Journal of Trauma Resuscitation & Emergency Medicine
Volume 27
ISSN 1757-7241
Publication year 2019
Published at Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
Language en
Links dx.doi.org/10.1186/s13049-019-0630-...
Keywords Stroke, Transient ischaemic attack, Income, Education, Prehospital delay, acute ischemic-stroke, emergency medical-services, delays, symptoms, health, population, knowledge, survival, income, level, Emergency Medicine
Subject categories Neurosciences

Abstract

Background and purposeRecent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).MethodsConsecutive stroke and TIA patients (n=3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient's neighbourhood (postcode area).ResultsThe median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3h 47min (95% confidence interval (CI) 3h 30min to 4h 05min) for patients within the lowest SES tertile and 3h 17min (95% CI 3h 00min to 3h 37min) for the highest tertile (p<0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p<0.05) and had lower rates of prehospital recognition of stroke/TIA (p<0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport.ConclusionsWe found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses' ability to recognise stroke/TIA may partly explain the observed inequities.

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