Abstract
ABSTRACT
Objectives
To examine the epidemiology of stroke and transient ischaemic attack (TIA), and quality of care provided to Aboriginal and Torres Strait Islander (‘Indigenous’) patients presenting to emergency medical services (EMSs) with stroke or TIA.
Design
Retrospective population‐based data linkage study.
Setting, Participants
Victoria, Australia. Patients aged ≥ 18 years with hospital‐confirmed stroke or TIA who presented to EMSs between 1 January 2015 and 30 June 2019 and were successfully linked with hospital or mortality datasets.
Main Outcome Measures
Thirty‐ and 90‐day mortality, crude and age‐standardised incidence rates, EMS quality of care.
Results
Among 32,163 patients, 287 (0.9%) were Indigenous. Indigenous patients were younger than non‐Indigenous patients (median age, 62 vs. 77 years,
p
p
= 0.001) and more frequently taken to stroke‐capable hospitals (257/275 [93.5%] vs. 27,371/30,647 [89.3%];
p
= 0.027), but less frequently taken to endovascular thrombectomy‐capable hospitals (67/275 [24.4%] vs. 10,015/30,647 [32.7%];
p
= 0.003). Adjusted mortality was similar between groups (30 days: hazard ratio, 0.814 [95% CI, 0.518–1.279]; 90 days: hazard ratio, 0.805 [95% CI, 0.534–1.214]). However, age‐standardised incidence of 90‐day mortality was higher within the Indigenous population (39 vs. 24 per 100,000 person‐years; incidence rate ratio, 1.621 [95% CI, 1.031–2.398]). Indigenous patients also more often recontacted EMSs for any reason within 90 days (subdistribution hazard ratio, 1.548 [95% CI, 1.194–2.007]).
Conclusions
The age‐standardised incidence of EMS attendance for stroke in the Indigenous population was more than double that for the non‐Indigenous population. Although there was no difference in stroke identification at the time of the emergency call, Indigenous patients were less likely to be evaluated by paramedics for stroke.