급성허혈뇌졸중 환자의 병원도착지연시간과 사회경제적 상태
Socioeconomic Status and Prehospital Delay in Acute Ischemic Stroke Patients
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Background: Prehospital delay in acute ischemic stroke makes many patients ineligible for acute treatment. The aim of this study was to investigate the socioeconomic status (SES) affects prehospital delays after ischemic stroke. Methods: We analyzed prospectively registered 236 patients with acute ischemic stroke who admitted the emergency department (ED) of 5 participating hospitals within 48 hours of symptoms onset. Household income, level of education, and family arrangement were used as indicators for SES. Prehospital delay was defined as time from symptom onset to the ED arrival. Bivariate and multivariable regression analyses were conducted to evaluate factors influencing ED arrival within 3 hours of symptom onset. Results: The median time of prehospital delay was 7.0 [interquartile range (IQR) 2.5 to 24] hours; 74 patients (31.4%) arrived within 3 hours and 114 (48.3%) within 6 hours. Patients living alone showed significantly longer prehospital delay (median 19 vs. 7 hours, P = 0.022). Multivariate analysis identified patients with monthly household income ≥ 3 × 106 KW [vs. < 0.99 × 106 KW, odds ratio (OR), 2.54; 95% confidence interval (CI), 1.1-5.85], high National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.08; 95% CI, 1.02-1.14), and stroke attributable to cardioembolism compared to small vessel occlusion (SVO) (OR, 3.09; 95% CI, 1.19-8.02) as being independently associated ED arrival within 3 hours of symptom onset. Conclusion: SES except living alone does not show a significant association with prehospital dealy, however, high income is associated with ED arrival within 3 hours of symptom onset. Policies are needed to reduce stroke disparity in ED arrival time.
Abstract
Background: Prehospital delay in acute ischemic stroke makes many patients ineligible for acute treatment. The aim of this study was to investigate the socioeconomic status (SES) affects prehospital delays after ischemic stroke. Methods: We analyzed prospectively registered 236 patients with acute ischemic stroke who admitted the emergency department (ED) of 5 participating hospitals within 48 hours of symptoms onset. Household income, level of education, and family arrangement were used as indicators for SES. Prehospital delay was defined as time from symptom onset to the ED arrival. Bivariate and multivariable regression analyses were conducted to evaluate factors influencing ED arrival within 3 hours of symptom onset. Results: The median time of prehospital delay was 7.0 [interquartile range (IQR) 2.5 to 24] hours; 74 patients (31.4%) arrived within 3 hours and 114 (48.3%) within 6 hours. Patients living alone showed significantly longer prehospital delay (median 19 vs. 7 hours, P = 0.022). Multivariate analysis identified patients with monthly household income ≥ 3 × 106 KW [vs. < 0.99 × 106 KW, odds ratio (OR), 2.54; 95% confidence interval (CI), 1.1-5.85], high National Institutes of Health Stroke Scale (NIHSS) score (OR, 1.08; 95% CI, 1.02-1.14), and stroke attributable to cardioembolism compared to small vessel occlusion (SVO) (OR, 3.09; 95% CI, 1.19-8.02) as being independently associated ED arrival within 3 hours of symptom onset. Conclusion: SES except living alone does not show a significant association with prehospital dealy, however, high income is associated with ED arrival within 3 hours of symptom onset. Policies are needed to reduce stroke disparity in ED arrival time.
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