title: Pre-hospital Delay after Acute Ischemic Stroke in Central Urban China: Prevalence and Risk Factors.
abstract: Timely thrombolytic treatment is paramount after acute ischemic stroke (AIS); however, a large proportion of patients experience substantial delays in presentation to hospital. This study evaluates the prevalence and risk factors in pre-hospital delays after AIS in central urban China. AIS patients from 66 hospitals in 13 major cities across Hubei Province, between October 1, 2014 and January 31, 2015 were interviewed and their medical records were reviewed to identify those who suffered pre-hospital delays. Bivariate and multivariate analyses were undertaken to determine the prevalence rates and the risk factors associated with pre-hospital delays. A total of 1835 patients were included in the analysis, with 69.3 % patients reportedly arrived at hospital 3 or more hours after onset and 55.3 % patients arrived 6 or more hours after onset. Factors associated with increased pre-hospital delays for 3 or more hours were as follows: patient had a history of stroke (odds ratio (OR), 1.319, P = 0.028), onset location was at home (OR, 1.573, P = 0.002), and patients rather than someone else noticed the symptom onset first (OR, 1.711; P < 0.001). In contrast, knowing someone who had suffered a stroke, considering any kind of the symptoms as severe, transferring from a community-based hospital factors, calling emergency number (120), and shorter distance from the onset place to the first hospital were independently associated with decreased pre-hospital delays. These findings indicate that pre-hospital delays after AIS are common in urban central China, and future intervention programs should be focused on public awareness of stroke and appropriate response.
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Yanfeng
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Tingting
authors.initials: T
authors.lastname: Yang
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Gong
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Wenzhen
authors.initials: W
authors.lastname: Li
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Yawen
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
authors.forename: Mengdie
authors.initials: M
authors.lastname: Wang
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. yinxiaoxv@yahoo.com.
authors.forename: Xiaoxv
authors.initials: X
authors.lastname: Yin
authors.affiliation: Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. hubo@mail.hust.edu.cn.|The Stroke Quality Control Center of Hubei Province, Wuhan, 430030, China. hubo@mail.hust.edu.cn.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. zuxunlu@yahoo.com.
authors.forename: Zuxun
authors.initials: Z
authors.lastname: Lu
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D002947:Cities / Q000453:epidemiology*; D003710:Demography; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000453:epidemiology*
keywords: Acute ischemia stroke; China; Pre-hospital delay; Prevalence