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) hours, 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) hours, 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.

Management of low back pain in Australian emergency departments for culturally and linguistically diverse populations from 2016 to 2021

“…In Australia, no difference was found in use of ambulance transport between immigrants and Australian-born patients with cardiovascular disease 16. However, in that study, immigrants were stratified into nine groups based on country of origin,16 whereas we integrated all immigrants into one group. Unlike in the USA, English proficiency and country of birth are as important, if not more so, than race and ethnicity when defining minority populations in Australia.…”

“…African-American patients with chest pain were also found to have a lower likelihood of hospital admission,14 whereas a higher rate of admission was reported in patients who required an interpreter relative to English-proficient patients 15. In Australia, no difference was found in use of ambulance transport between immigrants and Australian-born patients with cardiovascular disease 16. However, in that study, immigrants were stratified into nine groups based on country of origin,16 whereas we integrated all immigrants into one group.…”

The mortality risk after myocardial infraction in migrants compared with natives: a systematic review and meta-analysis

“…On the other hand, the healthy migration effect observed in many studies from North America to Europe, supported by evidence ranging from physical health to mental health, suggests that the migrant group is a selected healthier group and may contribute positively to the prognosis of migrants, especially at the early stage ( 43 – 45 ). However, only patients who were admitted to the hospital were enrolled, ignoring those who did not present to the hospital after MI, and previous studies suggest that migrants may receive inferior pre-hospital care, which may underestimate short-term mortality of migrants ( 46 , 47 ).…”