Racial/ethnic disparities in accessing emergency medical treatment among ischemic stroke patients

Introduction: Research shows racial/ethnic disparities exist in the risk factors and knowledge about stroke. Research has been limited concerning racial/ethnic disparities in arrival time to hospital after case was last known well, a key factor in determining access and type of treatment for stroke. Objectives: To identify racial/ethnic disparities in the arrival time to hospital emergency department (ED). Methods: Data was collected from 9 stroke centers and 911 calls in Santa Clara County, a large and diverse county in Northern California. A total of 3,236 ischemic stroke cases during 2010-2011 were used for analysis. Results: Racial/ethnic distribution of cases was 60% non-Hispanic Whites, 16% Hispanics, 13% Asians, and 5% African-Americans. Over half of cases used emergency medical services (EMS) to arrive at the hospital. The mean arrival time to ED from time case was last known well was shorter for cases transported by EMS (4.5 hours) compared to cases arriving by other means (5.5). One in 7 cases arrived within 3.5 hours of last known well. Mean arrival time was shorter for Hispanics (5.0 hours) and non-Hispanic Whites (5.4) compared to Asians (6.0) and African-Americans (7.0). Nearly 5% of cases received tPA treatment. Mean arrival time for cases treated with tPA was 1.8 hours. Conclusion: Racial/ethnic disparities exist in arrival times of ischemic stroke cases. Asians and African-Americans are less likely to arrive within the time interval for tPA treatment eligibility. A targeted countywide stroke awareness campaign is being developed based on these results to improve stroke knowledge and outcomes.