Key result
Aboriginal and Torres Strait Islander identity was associated with a higher incidence of EMS attendances for chest pain (3128 vs 1147 per 100,000 person-years; IRR 2.73, 95% CI 2.72-2.74).
Why the study?
The study was conducted to examine chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander patients presenting to hospital via emergency medical services with chest pain.
Cohort (n=204,969)
Yes
Relative Risk: 2.73 (95% CI 2.72–2.74)
Absolute Event Rate: 3128% vs 1147%
There are significant disparities in the incidence of acute chest pain and the quality of pre-hospital and hospital care provided to Indigenous Australians compared to the general population.
Highlights prehospital disparities for Indigenous Australians; leaves open whether targeted interventions narrow gaps.
Background: This study examined chest pain epidemiology and care quality for Aboriginal and Torres Strait Islander ('Indigenous') patients presenting to hospital via emergency medical services (EMS) with chest pain. Methods: State-wide population-based cohort study of consecutive patients attended by ambulance for acute chest pain with individual linkage to emergency, hospital admission and mortality data in the state of Victoria, Australia from January 2015 to June 2019. Multivariable models were used to assess for differences in pre-hospital and hospital adherence to care quality, process measures and clinical outcomes. Findings: From 204,969 EMS attendances for chest pain, 3890 attendances (1.9%) identified as Aboriginal or Torres Strait Islander. Age-standardized incidence rates were higher overall for Indigenous people (3128 vs. 1147 per 100,000 person-years, incidence rate ratio 2.73, 95% CI 2.72-2.74), this difference being particularly striking for younger patients, women, and those residing in outer regional areas. In multivariable models, adherence to care quality and process measures was lower for attendances involving Indigenous people. In the pre-hospital setting, Indigenous people were less likely to be provided intravenous access or analgesia. In the hospital setting, Indigenous people were less likely to be seen by emergency clinicians within target time and less likely to transferred following myocardial infarction to a revascularization capable centre. Interpretation: Incidence of acute chest pain presentations is high among Indigenous people in Victoria, Australia. Opportunities to improve the quality of care for Indigenous Australians presenting with acute chest pain are identified. Funding: National Health and Medical Research Council, National Heart Foundation.
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Dawson et al. (2023) conducted a cohort in acute chest pain (n=204,969). Aboriginal or Torres Strait Islander identity vs. Non-Indigenous identity was evaluated on Age-standardized incidence of EMS attendances for chest pain per 100,000 person-years (IRR 2.73, 95% CI 2.72-2.74). Aboriginal and Torres Strait Islander identity was associated with a higher incidence of EMS attendances for chest pain (3128 vs 1147 per 100,000 person-years; IRR 2.73, 95% CI 2.72-2.74).
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