title: Effect of socioeconomic status on out-of-hospital transport delays of patients with chest pain.
abstract: OBJECTIVE
  The effect of socioeconomic status on out-of-hospital care has not been widely examined. We determine whether socioeconomic status was associated with out-of-hospital transport delays for patients with chest pain.
  
  
  METHODS
  A retrospective study of patients with chest pain transported by means of ambulance in Toronto, Ontario, Canada, in 1999 was conducted. The primary outcome measure was the 90th percentile system response interval, with secondary outcomes being the 90th percentile on-scene interval, transport interval, and total out-of-hospital interval. Socioeconomic status was the primary independent variable. Covariates were age, sex, case severity, dispatch and return priority, time and day of transport, paramedic training, and percentage of high-rise apartments in the region.
  
  
  RESULTS
  Four thousand three hundred fifty-six patients met the inclusion criteria. The 90th percentile system response interval and total out-of-hospital interval were 11 minutes and 49 minutes, respectively. In multivariate analyses, the highest socioeconomic status neighborhoods were significantly associated with decreased system response interval (34.0 seconds; 95% confidence interval [CI] 6.2 to 70.9 seconds) and transport interval (132.3 seconds; 95% CI 24.1 to 229.6 seconds). In addition, age (+45.3 seconds per 10 years; 95% CI 13.3 to 75.1 seconds), female sex (+205.0 seconds; 95% CI 78.1 to 287.7 seconds), and advanced care paramedic crews (+371.6 seconds; 95% CI 263.3 to 490.1 seconds) were associated with delays in total out-of-hospital interval. Lastly, calls originating from the highest socioeconomic status neighborhoods were dispatched the highest proportion of advanced care paramedic crews, despite similar dispatch priorities and case severities.
  
  
  CONCLUSIONS
  High socioeconomic status neighborhoods were associated with shorter out-of-hospital transport intervals for patients with chest pain. In addition, out-of-hospital delays were associated with age, sex, and advanced care paramedic crew type, with calls from the highest socioeconomic status neighborhoods being most likely to receive advanced care paramedic crews.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Anand
authors.initials: A
authors.lastname: Govindarajan
authors.forename: Michael
authors.initials: M
authors.lastname: Schull
mesh_terms: D000367:Age Factors; D000368:Aged; D000488:Allied Health Personnel / Q000600:supply & distribution; D000704:Analysis of Variance; D002637:Chest Pain / Q000628:therapy*; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009864:Ontario; D011204:Poverty Areas; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012737:Sex Factors; D012923:Social Class; D013997:Time Factors; D014187:Transportation of Patients / Q000191:economics / Q000706:statistics & numerical data*