Abstract
Background and purposeRecent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).MethodsConsecutive stroke and TIA patients (n = 3006) admitted to stroke units at Sahlgrenska University Hospital, Gothenburg, Sweden, from 1 November 2014 to 31 July 2016, were included. Data on prehospital care were obtained from a local stroke register. Socioeconomic status was classified according to the average level of income and education within each patient’s neighbourhood (postcode area).ResultsThe median system delay from calling the emergency medical communication centre (EMCC) to start of brain computed tomography on hospital arrival was 3 h 47 min (95% confidence interval (CI) 3 h 30 min to 4 h 05 min) for patients within the lowest SES tertile and 3 h 17 min (95% CI 3 h 00 min to 3 h 37 min) for the highest tertile (p < 0.05). Patients with a lower SES were less likely to receive the highest priority in the ambulance (p < 0.05) and had lower rates of prehospital recognition of stroke/TIA (p < 0.05) than those with a high SES. No inequities were found concerning EMCC prioritisation or the probability of ambulance transport.ConclusionsWe found socioeconomic inequities in prehospital stroke care which could affect the efficacy of acute stroke treatment. The ambulance nurses’ ability to recognise stroke/TIA may partly explain the observed inequities.
Highlights
It is well known that socioeconomic status (SES) is a major determinant of health, quality of life and mortality
We studied factors contributing to system delay, including ambulance use, prioritisation by the emergency medical communication centre (EMCC) and in the ambulance and prehospital recognition of stroke and Transitory ischaemic attack (TIA) by the ambulance personnel
Data on age, sex, diagnosis of stroke or TIA, postcode of residence, date of stroke or TIA onset, date and time of calling the EMCC, priority given by the EMCC, ambulance transport, priority in the ambulance, prehospital recognition of stroke or TIA by the ambulance personnel and date and time for the start of the first brain Computed tomography (CT) scan on hospital arrival were obtained from Väststroke
Summary
It is well known that socioeconomic status (SES) is a major determinant of health, quality of life and mortality. Inequities in received stroke care have been shown throughout the entire care chain [4, 6,7,8,9,10,11,12], including the probability of receiving reperfusion therapy [4, 10,11,12]. These inequities may contribute to the observed disparities in stroke outcome. We investigated whether prehospital stroke care differs with respect to socioeconomic status (SES)
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