Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III

Abstract

Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23-0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended.

Keywords: ambulance utilization; chest pain; culturally and linguistically diverse; decision time; delay time; ethnicity; migrant; prehospital delay; seeking medical care.

Figure 1

Study flow diagram.

Figure 2

Comparisons of decision time (hours) and pre-hospital delay time (hours) between ethnic and Australian-born groups. Nth W Euro: North-West European, Sth E Euro: Southern and Eastern European, Nth E Asia: North-East Asian, Sth E Asia: South-East Asian, Sth Ct Asia: Southern and Central Asian, Middle East: North African and Middle Eastern, Americas: People of the Americas, Sub Africa: Sub-Saharan African. Decision time was defined as the interval from the time of symptom onset to accessing the emergency response system or to initiating travel to the hospital [26]. Prehospital delay time was defined as the interval between the time of symptom onset and hospital arrival [26,29]. * Significant differences between Australian and ethnic groups, p < 0.05 by Mann–Whitney U test.

Figure 3

Comparisons of proportion of patients seeking care for chest pain within one hour between ethnic and Australian-born groups.