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Accepted (AM)Open Access (License Unspecified), Open
Journal article
Neighborhood Influences on Emergency Medical Services Use for Acute Stroke: A Population-Based Cross-sectional Study
Annals of emergency medicine, v 67(3), pp 341-348.e4
Mar 2016
PMID: 26386884
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Delay to hospital arrival limits acute stroke treatment. Use of emergency medical services (EMS) is key in ensuring timely stroke care. We aim to identify neighborhoods with low EMS use and to evaluate whether neighborhood-level factors are associated with EMS use.
We conducted a secondary analysis of data from the Brain Attack Surveillance in Corpus Christi project, a population-based stroke surveillance study of ischemic stroke and intracerebral hemorrhage cases presenting to emergency departments in Nueces County, TX. The primary outcome was arrival by EMS. The primary exposures were neighborhood resident age, poverty, and violent crime. We estimated the association of neighborhood-level factors with EMS use, using hierarchic logistic regression, controlling for individual factors (stroke severity, ethnicity, and age).
During 2000 to 2009 there were 4,004 identified strokes, with EMS use data available for 3,474. Nearly half (49%) of stroke cases arrived by EMS. Adjusted stroke EMS use was lower in neighborhoods with higher family income (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.75 to 0.97) and a larger percentage of older adults (OR 0.70; 95% CI 0.56 to 0.89). Individual factors associated with stroke EMS use included white race (OR 1.41; 95% CI 1.13 to 1.76) and older age (OR 1.36 per 10-year age increment; 95% CI 1.27 to 1.46). The proportion of neighborhood stroke cases arriving by EMS ranged from 17% to 71%. The fully adjusted model explained only 0.3% (95% CI 0% to 1.1%) of neighborhood EMS stroke use variance, indicating that individual factors are more strongly associated with stroke EMS use than neighborhood factors.
Although some neighborhood-level factors were associated with EMS use, patient-level factors explained nearly all variability in stroke EMS use. In this community, strategies to increase EMS use should target individuals rather than specific neighborhoods.
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Details
- Title
- Neighborhood Influences on Emergency Medical Services Use for Acute Stroke: A Population-Based Cross-sectional Study
- Creators
- William J MeurerDeborah A Levine - University of MichiganKevin A Kerber - University of MichiganDarin B Zahuranec - University of MichiganJames Burke - University of MichiganJonggyu Baek - University of MichiganBrisa Sánchez - University of MichiganMelinda A Smith - University of MichiganLewis B Morgenstern - University of MichiganLynda D Lisabeth - University of Michigan
- Publication Details
- Annals of emergency medicine, v 67(3), pp 341-348.e4
- Publisher
- Elsevier
- Grant note
- R01 NS038916 / NINDS NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Epidemiology and Biostatistics
- Web of Science ID
- WOS:000371749700010
- Scopus ID
- 2-s2.0-84959555622
- Other Identifier
- 991020100085704721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Emergency Medicine