Ethnic and sex differences in ambulance activation among hospitalized patients with acute coronary syndromes: Insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study

Abstract

BackgroundWith acute coronary syndromes (ACS), activation of emergency medical services (EMS) ensures early treatment. However, EMS activation remains under-utilized. We examined whether ground EMS use varied by sex or ethnicity among a population-based cohort of ACS patients. MethodsWe used linked administrative health datasets to identify patients who were hospitalized with an ACS (April 1, 2002-March 31, 2016). Validated naming algorithms were used to categorize patients according to ethnicity (Caucasian, South Asian, Chinese). ResultsOf the 60,717 patients with an ACS (male: 41,175; female: 19,542), 42.3% presented to hospital via ground ambulance. Compared to males, females were more likely to activate EMS (38.9% vs. 49.3%, p < 0.001). Compared to the Caucasians (n = 58,666), EMS activation was significantly higher among Chinese (n = 793) (42.1% vs. 49.8%; p = 0.0007) and slightly higher in South Asians (n = 1258) (42.1% vs. 44.7%; p = 0.45). The relatively higher EMS use among females was maintained across the ethnic groups. In multivariable adjusted analyses, females were more likely to use EMS compared to males (OR: 1.31; 95% CI: 1.26–1.36). Compared to the Caucasians, a weaker trend towards South Asian and Chinese EMS activation was observed (OR: 1.08; 95% CI 0.96–1.21; OR: 1.10; 95% CI 0.95–1.28, respectively). In the male cohort only, South Asians and Chinese tended to activate EMS more often than the Caucasians (Males: South Asian OR: 1.14; 95% CI 1.00–1.31, Chinese OR: 1.15; 95% CI 0.96–1.38; Females: South Asian OR: 0.93; 95% CI 0.75–1.15, Chinese OR: 1.01; 95% CI 0.77–1.30). ConclusionEMS use was sub-optimal and differed based on sex and ethnicity. Our results reinforce the need for targeted public health efforts to enhance ambulance activation.