Shteyler Vadim M, Feldmeier Madeline, Bagay Richard Julian G, Ballard Dustin, Colwell Christopher, Hsia Renee Y
Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California, San Francisco.
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
JAMA Netw Open. 2025 May 1;8(5):e2510325. doi: 10.1001/jamanetworkopen.2025.10325.
Patient demographic and socioeconomic characteristics are associated with differential delays in access to emergency care. However, less is known about the association between demographic, socioeconomic, and emergency medical services (EMS) agency factors and ambulance patient offload times (APOT), a critical measure of timely access to emergency care.
To determine the association between ambulance offload times and demographic, socioeconomic, and EMS agency factors, uncover disparities in offload delays, and investigate factors associated with long APOT.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using offload data from the California EMS Authority and local EMS agencies (LEMSA), population data from the US Census Bureau, and demographic and socioeconomic data from the Centers for Disease Control and Prevention's Social Vulnerability Index. California local EMS agencies participated from January 1, 2021, to June 30, 2023.
A total of 30 community demographic, socioeconomic, and LEMSA factors were assessed.
The main outcome was weighted mean APOT, calculated from APOT measures obtained from the California Emergency Medical Services Authroity and LEMSAs. The association between APOT and area demographic and socioeconomic characteristics was assessed using linear regression.
In this retrospective study from January 1, 2021, to June 30, 2023, 5 913 399 offloads were observed across 34 California LEMSAs with median (IQR) of 0.3% (0.2%-0.4%) American Indian or Alaska Native residents, 7.1% (4.7%-1.5%) Asian residents, 2.2% (1.6%-4.9%) Black residents, 33.1% (22.5%-48.7%) Hispanic or Latino residents, 0.3% (0.2%-0.4%) Native Hawaiian or Pacific Islander residents, 4.1% (3.1%-4.9%) multiracial, and 0.4% (0.4%-0.5%) residents in the additional race category; 17.2% (14.7%-22.8%) residents living below 150% of the poverty line; and 15.7% (13.5%-20.1%) aged 65 years or older. The weighted mean (SD) APOT across California was 42.8 (27.3) minutes; the median (IQR) across LEMSAs was 27.0 (15.5-48.3) minutes. Sequential unadjusted linear regressions of the 30 characteristics revealed 11 that were significantly associated with APOT. Least absolute shrinkage and selection operator penalization identified Black race, being aged 65 years or older, and total offloads (all log-transformed) as the variables most associated with APOT. A 3.3% absolute increase in Black residents, from 1.6% (25th percentile) to 4.9% (75th percentile), was associated with an unadjusted 17.4-minute (95% CI 10.3-24.5) increase in APOT. This increase remained significant, at 11.75 (95% CI 1.9-21.6) minutes, after adjustments for demographic, socioeconomic, and LEMSA characteristics.
This cohort study of 5.9 million ambulance offloads found that the proportion of Black residents was the factor most significantly associated with longer APOT. These findings have direct implications for patients, EMS systems, and hospitals, as APOT may be an important component of health disparities in emergency care.
患者的人口统计学和社会经济特征与获得紧急护理的不同延迟相关。然而，关于人口统计学、社会经济和紧急医疗服务（EMS）机构因素与救护车患者卸载时间（APOT）之间的关联，人们了解较少，而APOT是衡量及时获得紧急护理的一项关键指标。
确定救护车卸载时间与人口统计学、社会经济和EMS机构因素之间的关联，揭示卸载延迟方面的差异，并调查与较长APOT相关的因素。
设计、设置和参与者：这项回顾性队列研究使用了加利福尼亚州EMS管理局和当地EMS机构（LEMSA）的卸载数据、美国人口普查局的人口数据以及疾病控制和预防中心社会脆弱性指数中的人口统计学和社会经济数据。加利福尼亚州当地EMS机构参与时间为2021年1月1日至2023年6月30日。
共评估了30个社区人口统计学、社会经济和LEMSA因素。
主要结局是加权平均APOT，根据从加利福尼亚州紧急医疗服务管理局和LEMSA获得的APOT测量值计算得出。使用线性回归评估APOT与地区人口统计学和社会经济特征之间的关联。
在这项从2021年1月1日至2023年6月30日的回顾性研究中，在加利福尼亚州的34个LEMSA中观察到5913399次卸载，其中美洲印第安人或阿拉斯加原住民居民占0.3%（四分位间距[IQR]为0.2%-0.4%），亚洲居民占7.1%（4.7%-1.5%），黑人居民占2.2%（1.6%-4.9%），西班牙裔或拉丁裔居民占33.1%（22.5%-48.7%），夏威夷原住民或太平洋岛民居民占0.3%（0.2%-0.4%），多种族居民占4.1%（3.1%-4.9%），其他种族居民占0.4%（0.4%-0.5%）；生活在贫困线150%以下的居民占17.2%（14.7%-22.8%）；65岁及以上的居民占15.7%（13.5%-20.1%）。加利福尼亚州的加权平均（标准差）APOT为42.8（27.3）分钟；LEMSA的中位数（IQR）为27.0（15.5-48.3）分钟。对这30个特征进行的连续未调整线性回归显示，有11个特征与APOT显著相关。最小绝对收缩和选择算子惩罚法确定黑人种族、65岁及以上年龄以及总卸载量（均进行对数转换）是与APOT最相关的变量。黑人居民比例从1.6%（第25百分位数）绝对增加3.3%至4.9%（第75百分位数），与未调整的APOT增加17.4分钟（95%置信区间10.3-24.5）相关。在对人口统计学、社会经济和LEMSA特征进行调整后，这种增加仍具有统计学意义，为11.75分钟（95%置信区间1.9-21.6）。
这项对590万次救护车卸载的队列研究发现，黑人居民比例是与较长APOT最显著相关的因素。这些发现对患者、EMS系统和医院具有直接影响，因为APOT可能是紧急护理中健康差异的一个重要组成部分。
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