Ethnic and sex differences in ambulance activation among hospitalized patients with acute coronary syndromes: Insights from the Alberta contemporary acute coronary syndrome patients invasive treatment strategies (COAPT) study.
International Journal of Cardiology · 2018-08-10 · Observational study
Abstract
BACKGROUND: With acute coronary syndromes (ACS), activation of emergency medical services (EMS) ensures early treatment. However, EMS activation remains under-utilized. We examined whether ground EMS use varied by sex or ethnicity among a population-based cohort of ACS patients. METHODS: We used linked administrative health datasets to identify patients who were hospitalized with an ACS (April 1, 2002-March 31, 2016). Validated naming algorithms were used to categorize patients according to ethnicity (Caucasian, South Asian, Chinese). RESULTS: Of the 60,717 patients with an ACS (male: 41,175; female: 19,542), 42.3% presented to hospital via ground ambulance. Compared to males, females were more likely to activate EMS (38.9% vs. 49.3%, p < 0.001). Compared to the Caucasians (n = 58,666), EMS activation was significantly higher among Chinese (n = 793) (42.1% vs. 49.8%; p = 0.0007) and slightly higher in South Asians (n = 1258) (42.1% vs. 44.7%; p = 0.45). The relatively higher EMS use among females was maintained across the ethnic groups. In multivariable adjusted analyses, females were more likely to use EMS compared to males (OR: 1.31; 95% CI: 1.26-1.36). Compared to the Caucasians, a weaker trend towards South Asian and Chinese EMS activation was observed (OR: 1.08; 95% CI 0.96-1.21; OR: 1.10; 95% CI 0.95-1.28, respectively). In the male cohort only, South Asians and Chinese tended to activate EMS more often than the Caucasians (Males: South Asian OR: 1.14; 95% CI 1.00-1.31, Chinese OR: 1.15; 95% CI 0.96-1.38; Females: South Asian OR: 0.93; 95% CI 0.75-1.15, Chinese OR: 1.01; 95% CI 0.77-1.30). CONCLUSION: EMS use was sub-optimal and differed based on sex and ethnicity. Our results reinforce the need for targeted public health efforts to enhance ambulance activation.