Racial/ethnic disparities in emergency department waiting time for stroke patients in the United States.
Emergency department waiting time (EDWT), the time from arrival at the ED to evaluation by an emergency physician, is a critical component of acute stroke care. We assessed racial/ethnic differences in EDWT in a national sample of patients with ischemic or hemorrhagic stroke. We identified 543 ED visits for ischemic stroke (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes 433.x1, 434.xx, and 436.xx) and hemorrhagic stroke (ICD-9-CM codes 430.xx, 431.xx, and 432.xx) in persons age ≥ 18 years representing 2.1 million stroke-related ED visits in the United States using the National Hospital Ambulatory Medical Care Survey for years 1997-2000 and 2003-2005. Using linear regression (outcome, log-transformed EDWT) and logistic regression (outcome, EDWT > 10 minutes, based on National Institute of Neurological Disorders and Stroke guidelines), we adjusted associations between EDWT and race/ethnicity (non-Hispanic whites [designated whites herein], non-Hispanic blacks [blacks], and Hispanics) for age, sex, region, mode of transportation, insurance, hospital characteristics, triage status, hospital admission, stroke type, and survey year. Compared with whites, blacks had a longer EDWT in univariate analysis (67% longer, P = .03) and multivariate analysis (62% longer, P = .03), but Hispanics had a similar EDWT in both univariate analysis (31% longer, P = .65) and multivariate analysis (5% longer, P = .91). Longer EDWT was also seen with nonambulance mode of arrival, urban hospitals, or nonemergency triage. Race was significantly associated with EDWT > 10 minutes (whites, 55% [referent]; blacks, 70% [P = .03]; Hispanics, 62% [P = .53]). These differences persisted after adjustment (blacks: odds ratio [OR] = 2.08, 95% confidence interval [CI] = 1.05-4.09; Hispanics: OR = 1.07, 95% CI = 0.52-2.22). Blacks, but not Hispanics, had significantly longer EDWT than whites. The longer EDWT in black stroke patients may lead to treatment delays and sub-optimal stroke care.
College of Pharmacy, Ohio State University, Columbus, Ohio (former institution); Department of Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina (current institution).
Sudeep J
SJ
Karve
Center for Medication Use, Policy and Economics, Schools of Pharmacy and Public Health, University of Michigan, Ann Arbor, Michigan.
Rajesh
R
Balkrishnan
Department of Neurology, Rush University Medical Center, Chicago, Illinois.
Yousef M
YM
Mohammad
Department of Internal Medicine, College of Medicine, and Division of Health Services Management & Policy, College of Public Health, Ohio State University, Columbus, Ohio (former institution); Ann Arbor VA Healthcare System, Departments of Medicine and Neurology, University of Michigan, Ann Arbor, Michigan (current institution). Electronic address: deblevin@umich.edu.
Deborah A
DA
Levine
D000293:Adolescent; D000328:Adult; D000368:Aged; D044383:Black People; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000150:complications; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005006:Ethnicity; D005260:Female; D006630:Hispanic or Latino; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010067:Ownership; D011153:Population; D012189:Retrospective Studies; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014218:Triage; D014481:United States / Q000453:epidemiology; D055815:Young Adult; D001741:Black or African American