Race-ethnic disparities in hospital arrival time after ischemic stroke

Mellanie V. Springer, Daniel L. Labovitz, Ethan C. Hochheiser

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Conflicting reports exist about hospital arrival time after stroke onset in Hispanics compared with African Americans and Caucasians. Our current study investigates race-ethnic disparities in hospital arrival times after stroke onset. Methods: We performed a retrospective analysis of hospital arrival times in Hispanic, African American, and Caucasian acute ischemic stroke patients (N=1790) presenting to a tertiary-care hospital in the Bronx, New York. A multivariable logistic regression model was used to identify the association between race-ethnicity and hospital arrival time adjusting for age, sex, socioeconomic status (SES), NIH stroke scale (NIHSS), history of stroke, preferred language and transportation mode to the hospital. Results: There were 338 Caucasians, 662 Hispanics, and 790 African Americans in the cohort. Compared with Caucasians, African Americans and Hispanics were younger (P<.0001 respectively), had lower SES (P<.001 respectively) and were less likely to use EMS (P=.003 and P=.001, respectively). A greater proportion of Hispanic and African American women had delayed hospital arrival times (≥3 hours) after onset of stroke symptoms compared with Caucasian women (74% of Hispanic, 72% of African American, and 59% of Caucasian women), but this difference between race-ethnicities is no longer present after adjusting for socioeconomic status. Compared with Caucasian men, hospital arrival ≥3 hours after symptom onset was more likely for African American men (OR 1.72, 95% CI:1.05-2.79) but not Hispanic men (OR .80, 95% CI .49-1.30). Conclusions: African American men and socially disadvantaged women delay in presenting to the hospital after stroke onset. Future research should focus on identifying the factors contributing to pre-hospital delay among race-ethnic minorities.

Original languageEnglish (US)
Pages (from-to)125-132
Number of pages8
JournalEthnicity and Disease
Volume27
Issue number2
DOIs
StatePublished - Mar 1 2017

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African Americans
Hispanic Americans
Stroke
Social Class
Logistic Models
Vulnerable Populations
Tertiary Healthcare
Tertiary Care Centers
Language

Keywords

  • African Americans
  • Delay
  • Health care disparities
  • Hispanics
  • Race
  • Stroke

ASJC Scopus subject areas

  • Epidemiology
  • Medicine(all)

Cite this

Race-ethnic disparities in hospital arrival time after ischemic stroke. / Springer, Mellanie V.; Labovitz, Daniel L.; Hochheiser, Ethan C.

In: Ethnicity and Disease, Vol. 27, No. 2, 01.03.2017, p. 125-132.

Research output: Contribution to journalArticle

Springer, Mellanie V. ; Labovitz, Daniel L. ; Hochheiser, Ethan C. / Race-ethnic disparities in hospital arrival time after ischemic stroke. In: Ethnicity and Disease. 2017 ; Vol. 27, No. 2. pp. 125-132.
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abstract = "Objective: Conflicting reports exist about hospital arrival time after stroke onset in Hispanics compared with African Americans and Caucasians. Our current study investigates race-ethnic disparities in hospital arrival times after stroke onset. Methods: We performed a retrospective analysis of hospital arrival times in Hispanic, African American, and Caucasian acute ischemic stroke patients (N=1790) presenting to a tertiary-care hospital in the Bronx, New York. A multivariable logistic regression model was used to identify the association between race-ethnicity and hospital arrival time adjusting for age, sex, socioeconomic status (SES), NIH stroke scale (NIHSS), history of stroke, preferred language and transportation mode to the hospital. Results: There were 338 Caucasians, 662 Hispanics, and 790 African Americans in the cohort. Compared with Caucasians, African Americans and Hispanics were younger (P<.0001 respectively), had lower SES (P<.001 respectively) and were less likely to use EMS (P=.003 and P=.001, respectively). A greater proportion of Hispanic and African American women had delayed hospital arrival times (≥3 hours) after onset of stroke symptoms compared with Caucasian women (74{\%} of Hispanic, 72{\%} of African American, and 59{\%} of Caucasian women), but this difference between race-ethnicities is no longer present after adjusting for socioeconomic status. Compared with Caucasian men, hospital arrival ≥3 hours after symptom onset was more likely for African American men (OR 1.72, 95{\%} CI:1.05-2.79) but not Hispanic men (OR .80, 95{\%} CI .49-1.30). Conclusions: African American men and socially disadvantaged women delay in presenting to the hospital after stroke onset. Future research should focus on identifying the factors contributing to pre-hospital delay among race-ethnic minorities.",
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