Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III.

Kannikar Hannah Wechkunanukul,Shahid Ullah,Justin Beilby

doi:10.3390/ijerph19031516

Abstract

Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23–0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended.

Highlights

Introduction published maps and institutional affilGlobally, pre-hospital delay times have varied from country to country, even between countries in the same continent [1]
The 213 patients were first excluded due to unclassified country of birth, leaving 8012 patients included in the step
All patients were allocated into two groups; 2613 (32.6%) migrant patients and 5399 (67.4%) Australianborn patients, based on their countries of birth

Summary

Introduction

Pre-hospital delay times have varied from country to country, even between countries in the same continent [1]. The cognitive and emotional response of the patient, and psychological and social factors were found to be associated with longer delay times [3,4], as were ethnicity and cultural factors [5,6]. Variations in characteristics (e.g., age, education level, socioeconomic status), symptoms (e.g., symptom recognition, perception of pain, severity of pain), and outcomes (e.g., mortality rate, readmission rate) among ethnic groups have been reported in previous studies [6,7,8]. One study revealed a low level of awareness of myocardial infarction (MI) symptoms and inappropriate response to MI symptoms among migrants in the USA [10]

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