Racial/Ethnic and Sex Differences in Emergency Medical Services Transport Among Hospitalized US Stroke Patients: Analysis of the National Get With The Guidelines-Stroke Registry.
BACKGROUND
Differences in activation of emergency medical services (EMS) may contribute to racial/ethnic and sex disparities in stroke outcomes. The purpose of this study was to determine whether EMS use varied by race/ethnicity and sex among a current, diverse national sample of hospitalized acute stroke patients.


RESULTS
We analyzed data from 398,798 stroke patients admitted to 1613 Get With The Guidelines-Stroke participating hospitals between October 2011 and March 2014. Multivariable logistic regression was used to evaluate the associations between combinations of racial/ethnic and sex groups with EMS use, adjusting for potential confounders including demographics, medical history, and stroke symptoms. Patients were 50% female, 69% white, 19% black, 8% Hispanic, 3% Asian, and 1% other, and 86% had ischemic stroke. Overall, 59% of stroke patients were transported to the hospital by EMS. White women were most likely to use EMS (62%); Hispanic men were least likely to use EMS (52%). After adjustment for patient characteristics, Hispanic and Asian men and women had 20% to 29% lower adjusted odds of using EMS versus their white counterparts; black women were less likely than white women to use EMS (odds ratio 0.75, 95% CI 0.72 to 0.77). Patients with weakness or paresis, altered level of consciousness, and/or aphasia were significantly more likely to use EMS than patients without each symptom; the observed racial/ethnic and sex differences in EMS use remained significant after adjustment for stroke symptoms.


CONCLUSIONS
EMS use differed by race/ethnicity and sex. These contemporary data document suboptimal use of EMS transport among US stroke patients, especially by racial/ethnic minorities and those with less recognized stroke symptoms.
Columbia University Medical Center, New York, NY (H.M.G.).
Heidi
H
Mochari-Greenberger
Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.).
Ying
Y
Xian
Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.).
Anne S
AS
Hellkamp
Duke Clinical Research Institute, Durham, NC (Y.X., A.S.H., P.J.S.).
Phillip J
PJ
Schulte
Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.).
Deepak L
DL
Bhatt
David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F., J.L.S.).
Gregg C
GC
Fonarow
David Geffen School of Medicine, University of California at Los Angeles, CA (G.C.F., J.L.S.).
Jeffrey L
JL
Saver
Michigan State University, East Lansing, MI (M.J.R.).
Mathew J
MJ
Reeves
Massachusetts General Hospital, Boston, MA (L.H.S.).
Lee H
LH
Schwamm
Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.).
Eric E
EE
Smith
D001741:Black or African American / Q000523:psychology; D000368:Aged; D001213:Asian / Q000523:psychology; D016009:Chi-Square Distribution; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006630:Hispanic or Latino / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012042:Registries; D012737:Sex Factors; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology* / Q000523:psychology / Q000628:therapy*; D014187:Transportation of Patients / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D044465:White People / Q000523:psychology
disparities; emergency medical services; race/ethnicity; sex; stroke