title: Ethnicity and pre-hospital care for people with suspected cardiac pain: cross-sectional study.
abstract: OBJECTIVE
  Few studies have investigated the quality of pre-hospital care by ethnicity. We aimed to investigate ethnic differences in pre-hospital ambulance care of patients with suspected cardiac pain.
  
  
  METHODS
  We conducted a cross-sectional analysis of retrospective electronic clinical data for patients with suspected cardiac pain over one year (August 2011 to July 2012) extracted from a single regional ambulance service. This included patient demographic data, clinical measurements, drugs administered and outcomes, such as transportation to hospital or referral to primary care. We used multivariate regression to investigate differences in care by ethnicity comparing non-White with White patients.
  
  
  RESULTS
  There were 7046 patients with suspected cardiac pain, with 4825 who had ethnicity recorded including 4661 (96.6%) White and 164 (3.4%) non-White. After correcting for age, sex, socio-economic status and whether transported to hospital, non-White patients were significantly more likely to have temperature [odds ratio (OR) 2.96, P = 0.007], blood glucose (OR 3.95, P = 0.003), respiratory rate (OR 4.94, P = 0.03) and oxygen saturation (OR 2.43, P = 0.006) recorded. Non-White patients were significantly less likely to be transported to hospital (OR 0.43, P = 0.03).
  
  
  CONCLUSIONS
  There were significant differences in pre-hospital ambulance care for non-White compared with White patients with suspected cardiac pain. These differences could be due to differences in clinical condition or case-mix, language and cultural barriers, limited understanding of appropriate use of health care services, recording bias or true differences in provider management. Further analysis should involve larger and more complete data sets to explore ethnic differences in greater detail.
authors.affiliation: Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK.
authors.forename: Zahid
authors.initials: Z
authors.lastname: Asghar
authors.affiliation: Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK.
authors.forename: Viet-Hai
authors.initials: VH
authors.lastname: Phung
authors.affiliation: Community and Health Research Unit, School of Health and Social Care, University of Lincoln, Lincoln, LN6 7TS, UK. nsiriwardena@lincoln.ac.uk.|East Midlands Ambulance Service NHS Trust, UK. nsiriwardena@lincoln.ac.uk.
authors.forename: Aloysius Niroshan
authors.initials: AN
authors.lastname: Siriwardena
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000208:ethnology; D002637:Chest Pain / Q000208:ethnology*; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: analgesia; emergency medical services; pain; paramedic; pre-hospital care