Cargando…

Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study

We analyzed the associations between area-level socioeconomic status (SES) and prehospital delay in acute ischemic stroke (AIS) patients by degree of urbanization with the use of an ecological framework. The participants were 13,637 patients over 18 years of age who experienced AIS from 2007 to 2012...

Descripción completa

Detalles Bibliográficos
Autores principales: Park, Hang A, Lee, Hye Ah, Park, Ju Ok
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600419/
https://www.ncbi.nlm.nih.gov/pubmed/33050565
http://dx.doi.org/10.3390/ijerph17207392
_version_ 1783603139451027456
author Park, Hang A
Lee, Hye Ah
Park, Ju Ok
author_facet Park, Hang A
Lee, Hye Ah
Park, Ju Ok
author_sort Park, Hang A
collection PubMed
description We analyzed the associations between area-level socioeconomic status (SES) and prehospital delay in acute ischemic stroke (AIS) patients by degree of urbanization with the use of an ecological framework. The participants were 13,637 patients over 18 years of age who experienced AIS from 2007 to 2012 and were admitted to any of the 29 hospitals in South Korea. Area-level SES was determined using 11 variables from the 2010 Korean census. The primary outcome was a prehospital delay (more than three hours from AIS onset time). Multilevel logistic regression was conducted to define the associations of individual- and area-level SES with prehospital delay after adjusting for confounders, which includes the use of emergency medical services (EMS) and individual SES. After adjusting for covariates, it was found that the area-level SES and urbanization were not associated with prehospital delay and EMS use was beneficial in both urban and rural areas. However, after stratification by urbanization, low area-level SES was significantly associated with a prehospital delay in urban areas (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 1.04–1.47) but not in rural areas (aOR 1.04, 95% CI 0.78–1.38). Therefore, we posit that area-level SES in urban areas might be a significant barrier to improving prehospital delay in AIS patients.
format Online
Article
Text
id pubmed-7600419
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-76004192020-11-01 Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study Park, Hang A Lee, Hye Ah Park, Ju Ok Int J Environ Res Public Health Article We analyzed the associations between area-level socioeconomic status (SES) and prehospital delay in acute ischemic stroke (AIS) patients by degree of urbanization with the use of an ecological framework. The participants were 13,637 patients over 18 years of age who experienced AIS from 2007 to 2012 and were admitted to any of the 29 hospitals in South Korea. Area-level SES was determined using 11 variables from the 2010 Korean census. The primary outcome was a prehospital delay (more than three hours from AIS onset time). Multilevel logistic regression was conducted to define the associations of individual- and area-level SES with prehospital delay after adjusting for confounders, which includes the use of emergency medical services (EMS) and individual SES. After adjusting for covariates, it was found that the area-level SES and urbanization were not associated with prehospital delay and EMS use was beneficial in both urban and rural areas. However, after stratification by urbanization, low area-level SES was significantly associated with a prehospital delay in urban areas (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 1.04–1.47) but not in rural areas (aOR 1.04, 95% CI 0.78–1.38). Therefore, we posit that area-level SES in urban areas might be a significant barrier to improving prehospital delay in AIS patients. MDPI 2020-10-11 2020-10 /pmc/articles/PMC7600419/ /pubmed/33050565 http://dx.doi.org/10.3390/ijerph17207392 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Park, Hang A
Lee, Hye Ah
Park, Ju Ok
Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study
title Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study
title_full Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study
title_fullStr Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study
title_full_unstemmed Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study
title_short Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study
title_sort association between area-level socioeconomic deprivation and prehospital delay in acute ischemic stroke patients: an ecological study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600419/
https://www.ncbi.nlm.nih.gov/pubmed/33050565
http://dx.doi.org/10.3390/ijerph17207392
work_keys_str_mv AT parkhanga associationbetweenarealevelsocioeconomicdeprivationandprehospitaldelayinacuteischemicstrokepatientsanecologicalstudy
AT leehyeah associationbetweenarealevelsocioeconomicdeprivationandprehospitaldelayinacuteischemicstrokepatientsanecologicalstudy
AT parkjuok associationbetweenarealevelsocioeconomicdeprivationandprehospitaldelayinacuteischemicstrokepatientsanecologicalstudy