Socioeconomic status and waiting time in the emergency department for patients with chest pain

Abstract

Introduction: Acute coronary syndrome (ACS) is one of the leading causes of death in the world and timeliness of treatment and diagnosis is of utmost importance to reduce mortality and morbidity. Emergency department (ED) crowding results in longer waiting times and length of stay in the ED and is a globally growing phenomenon with clear negative consequences for patients. Low socioeconomic status (SES) has previously been associated with poor prognosis after ACS, but it remains unclear if treatment and diagnostics in the acute state is a contributing factor. ED length of stay has been linked to crowding and poor patient outcomes whereas mechanisms for generally worse prognosis in low SES remains poorly understood. Purpose: To investigate whether SES, measured as disposable income, is associated with ED waiting times among patients with the most common chief complaint in ACS, chest pain. Methods: A registry-based cohort study on all 140,388 patients arriving at 14 Swedish emergency departments between 2015 and 2019 with chest pain as their chief complaint registered in the Swedish Emergency Registry (SVAR). Individual-level sociodemographic and clinical data were linked from multiple national registries. The associations between disposable income quintiles and ED length of stay and time to doctor were assessed using multivariable regression models adjusting for age, sex, education, comorbidities (diabetes, hypertension, hyperlipidemia, obesity and cardiovascular disease) and ED-visit characteristics (arrival mode, triage level, arrival time (day, evening or night as well as weekday or weekend) and hospital type). Results: Median length of stay was 11 minutes (4.4%) longer among patients in the lowest income quintile, 4:04 [hours:minutes] (95% confidence interval [CI] 4:02-4:05), compared to patients in the highest income quintile (3:53, 95% CI 3:52-3:55). Similarly, time to doctor was 6 min (8.7%) longer among patients in the lowest income quintile (1:15 min, 95% CI 1:14-1:16) than patients in the highest income quintile (1:09, 95% CI 1:08-1:10). The associations were independent of adjustment for studied confounders and mediators. Conclusions: Among ED chest pain patients, low income was associated with longer length of stay and time to doctor which may impact negatively on patients with serious cardiovascular diagnosis such as ACS. Longer waiting times may delay diagnosis and timely treatment for the individual patient such as anti-ischemic and antithrombotic therapy.