Source/Disclosures
Source:

Friedson AI. JAMA Netw Open. 2018;doi:10.1001/jamanetworkopen.2018.5201.Hsia RY, et al. JAMA Netw Open. 2018;doi:10.1001/jamanetworkopen.2018.5202.

November 30, 2018
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EMS times for cardiac arrest longer in poor neighborhoods

Source/Disclosures
Source:

Friedson AI. JAMA Netw Open. 2018;doi:10.1001/jamanetworkopen.2018.5201.Hsia RY, et al. JAMA Netw Open. 2018;doi:10.1001/jamanetworkopen.2018.5202.

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Patients from poor neighborhoods with cardiac arrest had longer emergency medical services times compared with those who lived in wealthy neighborhoods, according to a study published in JAMA Network Open.

Response times for low-income areas were also less likely to meet national benchmarks, according to the study.

“Our findings are disturbing given that poorer neighborhoods have higher rates of disease and other structural disparities in health care access that further compound their risk for worse outcomes,” Renee Y. Hsia, MD, MSc, professor in the department of emergency medicine at University of California, San Francisco, and colleagues wrote. “Our study shows that these structural disparities begin as early as the initial [emergency medical services] activation and the resulting services, which is an area previously more traditionally administered by public services and considered less vulnerable to market forces.”

EMS information

Researchers analyzed data from 63,600 encounters (mean age, 61 years; 58% men) for cardiac arrest from the 2014 National Emergency Medical Services (EMS) Information System. Information from the system was derived from standardized EMS patient care reports, including clinical information, patient demographics, dispatch times, interventions performed and transport data. EMS activations for cardiac arrest included in the study were for patients who did not die on the scene and were taken to a hospital.

Patients were categorized as living in high-income (n = 37,550) or low-income communities (n = 8,192).

The primary outcome involved critical points during the EMS encounter: response time, on-scene time, transport time and total EMS time.

Compared with patients from low-income areas, those who lived in high-income areas were more likely to be white (70.1% vs. 62.2%; P < .001), men (58.8% vs. 54.1%; P < .001), privately insured (29.4% vs. 15.9%; P < .001) and uninsured (15.3% vs. 7.9%; P < .001), the researchers wrote. Patients from low-income areas were also more likely to be insured by Medicaid vs. those from high-income areas (38.3% vs. 15.8%; P < .001).

The mean total EMS time was shorter in the highest ZIP code income quartile compared with the lowest ZIP code income quartile (37.5 minutes vs. 43 minutes; P < .001), according to the study. This time was 10%, or 3.8 minutes, longer (95% CI, 9-11) for low-income ZIP codes vs. high-income ZIP codes after controlling for weekday, urban ZIP code and time of day.

National benchmarks

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More EMS responses for patients in high-income areas met 8-minute and 15-minute marks compared with low-income areas (8 minutes: 78.1% vs. 72.4%; 15 minutes: 96.7% vs. 92.7%; P for both comparisons < .001).

“Understanding where gaps exist can help guide improvements in policies and develop interventions to address prehospital care disparities and, ultimately, disparities in patient outcomes,” Hsia and colleagues wrote.

“There is no denying that the association between income and ambulance response times is important, and shines a light on inequality not just in wealth, but in health care opportunities in the United States,” Andrew Friedson, PhD, assistant professor in the department of economics at University of Colorado Denver, wrote in a related editorial. “However, it is important to understand that the reason for this inequality is not completely understood, and the cause or more likely group of causes responsible for response time inequality may require more than one single policy approach if the societal goal is to close the income-based gap in access to high-quality emergency transport.” – by Darlene Dobkowski

Disclosures: The authors and Friedson report no relevant financial disclosures.