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

Hang A Park, Hye Ah Lee and Ju Ok Park
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Hang A Park: Department of Emergency Medicine, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Chuncheon 18450, Korea
Hye Ah Lee: Clinical Trial Center, Mokdong Hospital, Ewha Womans University, Seoul 07985, Korea
Ju Ok Park: Department of Emergency Medicine, Hallym University College of Medicine, Dongtan Sacred Heart Hospital, Chuncheon 18450, Korea

IJERPH, 2020, vol. 17, issue 20, 1-12

Abstract: 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.

Keywords: stroke; socioeconomic status; prehospital delay (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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