Disparities in inter-hospital helicopter transportation for Hispanics by geographic region: a threat to fairness in the era of thrombectomy
Abstract
Background and purpose Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients.Methods Acute ischemic stroke patients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders.Results A total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019).Discussion Our findings suggest there is a disparity in the use of HEMS in Hispanic stroke patients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.
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- Authors
- Vaughan Sarrazin, M., Limaye, K., Samaniego, E. A., Al Kasab, S., Sheharyar, A., Dandapat, S., Guerrero, W. R., Hasan, D. M., Ortega-Gutierrez, S., Derdeyn, C. P., Torner, J. C., Chamorro, A., & Leira, E. C.
- Affiliations
- University of Iowa (US)
- Corresponding author
- Limaye, Kaustubh
- Samaniego, Edgar A.
- Dandapat, Sudeepta
- Guerrero, Waldo R.
- Hasan, David M.
- Derdeyn, Colin P.
- Torner, James C.
- Leira, Enrique C.
- ORCID
- Venue
- Journal of Stroke and Cerebrovascular Diseases
- Publisher
- Elsevier BV
- Published
- 2019-03
- Volume
- 28
- Issue
- 3
- Pages
- 550-556
- ISSN
- 1052-3057 (ISSN-L)
- OpenAlex
- W2904077702
- Cited by
- 18
- References
- 30
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 2 · 2022: 8 · 2021: 3 · 2020: 3
- FWCI
- 1.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Stroke and Cerebrovascular Diseases (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (AHRQ R01 HS023104)
- Health Services Research and Development Service (HSR&D)
- Topics
- Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- helicopter emergency medical services, interhospital transfer, acute ischemic stroke, mechanical thrombectomy, racial and ethnic disparities, Hispanic patients, non-Hispanic Black patients, geographic disparities, Southern United States, mode of transportation
- MeSH terms
- Administrative Claims, Healthcare, Aged, Aged, 80 and over, Black or African American, Catchment Area, Health, Brain Ischemia, Female, Medicare, Health Services Accessibility, Hispanic or Latino, Humans, Male, Retrospective Studies, Time Factors, United States, Databases, Factual, Treatment Outcome, Thrombectomy, Air Ambulances, Stroke, White People, Healthcare Disparities, Time-to-Treatment
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