267908 Racial/ethnic disparities in accessing emergency medical treatment among ischemic stroke patients

Monday, October 29, 2012

Mandeep Baath, MPH , Public Health Department, Santa Clara County, San Jose, CA
Anne Marcotte, RN, MSN , Emergency Medical Services, Santa Clara County, San Jose, CA
Michael Petrie, EMT-P, MBA, MA , Emergency Medical Services, Santa Clara County, San Jose, CA
Dan Peddycord, RN , Public Health Department, Santa Clara County, San Jose, CA
Eric Rudnick, MD, FACEP , Emergency Medical Services, Santa Clara County, San Jose, CA
Rocio Luna, MPH , Public Health Department, Santa Clara County, San Jose, CA
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.

Learning Areas:
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
Identify racial/ethnic disparities among ischemic stroke cases in the time interval between arrival time to the hospital emergency department and time when the case was last known well. Identify racial/ethnic disparities in the use of Emergency Medical Services and tPA treatment among the ischemic stroke cases.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been working as a chronic disease and EMS epidemiologist. My work includes providing data and evaluation support for the chronic disease health education and prevention programs, develop health education campaigns and health promotion policies. While working for EMS, my focus has been stroke prevention and treatment.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.