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Socioeconomic disparities in prehospital stroke care.
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg.
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.ORCID iD: 0000-0003-4139-6235
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg.
2019 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 27, no 1, article id 53Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND PURPOSE: Recent studies have revealed socioeconomic disparities in stroke outcomes. Here, we investigated whether prehospital stroke care differs with respect to socioeconomic status (SES).

METHODS: Consecutive 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).

RESULTS: The 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.

CONCLUSIONS: We 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.

Place, publisher, year, edition, pages
2019. Vol. 27, no 1, article id 53
Keywords [en]
Education, Income, Prehospital delay, Stroke, Transient ischaemic attack
National Category
Neurology
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-22162DOI: 10.1186/s13049-019-0630-6ISI: 000466937800001PubMedID: 31046804Scopus ID: 2-s2.0-85065260443OAI: oai:DiVA.org:hb-22162DiVA, id: diva2:1376432
Available from: 2019-12-09 Created: 2019-12-09 Last updated: 2019-12-20Bibliographically approved

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