Socioeconomic status is associated with process times in the emergency department for patients with chest pain

Sebastian Herlitz; Joel Ohm; Henrike Häbel; Ulf Ekelund; Robin Hofmann; Per Svensson

doi:10.1002/emp2.13005

Socioeconomic status is associated with process times in the emergency department for patients with chest pain

J Am Coll Emerg Physicians Open. 2023 Jul 8;4(4):e13005. doi: 10.1002/emp2.13005. eCollection 2023 Aug.

Authors

Sebastian Herlitz¹, Joel Ohm^{2

3}, Henrike Häbel⁴, Ulf Ekelund⁵, Robin Hofmann^{1

6}, Per Svensson^{1

6}

Affiliations

¹ Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden.
² Department of Medicine, Solna Karolinska Institutet Stockholm Sweden.
³ Coagulation Unit, Department of Hematology Karolinska University Hospital Solna Stockholm Sweden.
⁴ Department of Learning, Informatics, Management, and Ethics, Solna Karolinska Institutet Stockholm Sweden.
⁵ Emergency Medicine, Department of Clinical Sciences Lund, Lund University Skåne University Hospital Lund Sweden.
⁶ Department of Cardiology Södersjukhuset Stockholm Sweden.

Abstract

Objective: Emergency department length of stay (EDLOS) is linked to crowding and patient outcomes whereas worse prognosis in low socioeconomic status remains poorly understood. We studied whether income was associated with ED process times among patients with chest pain.

Methods: This was a registry-based cohort study on 124,980 patients arriving at 14 Swedish EDs between 2015 and 2019 with chest pain as their chief complaint. Individual-level sociodemographic and clinical data were linked from multiple national registries. The associations between disposable income quintiles, whether the time to physician assessment exceeded triage priority recommendations as well as EDLOS were evaluated using crude and multivariable regression models adjusted for age, gender, sociodemographic variables, and ED-management circumstances.

Results: Patients with the lowest income were more likely to be assessed by physician later than triage recommendations (crude odds ratio [OR] 1.25 (95% confidence interval [CI] 1.20-1.29) and have an EDLOS exceeding 6 h (crude OR 1.22 (95% CI 1.17-1.27). Among patients subsequently diagnosed with major adverse cardiac events, patients with the lowest income were more likely to be assessed by a physician later than triage recommendations, crude OR 1.19 (95% CI 1.02-1.40). In the fully adjusted model, the average EDLOS was 13 min (5.6%) longer among patients in the lowest income quintile, 4:11 [h:min], (95% CI 4:08-4:13), compared to patients in the highest income quintile, 3:58 (95% CI 3:56-4:00).

Conclusions: Among ED chest pain patients, low income was associated with longer time to physician than recommended by triage and longer EDLOS. Longer process times may have a negative impact due to crowding in the ED and delay diagnosis and timely treatment of the individual patient.

Keywords: acute coronary syndrome; emergency department; length of stay; socioeconomic status; time to physician assessment.