Disparities of Aspirin Administration for Prehospital Chest Pain and ST Elevation Myocardial Infarctions

Although disparities exist in aspirin administration for chest pain and ST elevation myocardial infarctions (STEMI), little is known about community-based disparities in aspirin administration for prehospital patients. We evaluated disparities in prehospital aspirin using a national prehospital database.

We conducted a retrospective analysis of the 2018-2021 NEMSIS database linked to census data, including adult prehospital encounters. We created two cohorts: dispatch reason of chest pain and identified STEMI on prehospital EKG. We stratified patients based on majority ZIP Code race/ethnicity (>50% White, Black, and Hispanic) and into quartiles based on household income. Using multivariable logistic regression, we evaluated the association between incident community characteristics and aspirin administration.

We included 4,881,663 chest pain encounters and 184,610 STEMIs. Chest pain encounters in majority White communities (32.3%) received aspirin more often for chest pain than Black (22.1%; aOR 0.59, [0.59-0.60]) or Hispanic (24.8%; aOR 0.66, [0.66-0.67]) communities. Compared to the top income quartile (29.0%), the lowest income quartile had lower odds of aspirin administration (4th-27.6%; aOR 0.93, [0.92-0.94]). For STEMIs, adjusted odds of aspirin administration were higher for White (53.4%) than Black (52.5%; aOR 0.81, [0.78-0.84]) or Hispanic (53.6%; aOR 0.93, [0.89-0.96]) patients. Compared to the highest income quartile (55.0%), lower quartiles had lower odds of aspirin administration (2nd-54.2%; aOR 0.95, [0.92-0.97]; 3rd-52.9%; aOR 0.93, [0.91-0.96]; 4th-52.0%; aOR 0.86, [0.84-0.89]).

Patients from Black, Hispanic/Latino, and lowest-income communities received aspirin for chest pain at a lower rate than white or high-income patients.