Racial and Socioeconomic Disparities in California Ambulance Patient Offload Times

Area of Science:

• Emergency Medicine
• Health Services Research
• Health Disparities

Background:

• Patient demographics and socioeconomic factors influence emergency care access.
• Ambulance patient offload times (APOT) are a key indicator of emergency care timeliness.
• Limited research exists on factors associated with APOT, including EMS agency characteristics.

Purpose of the Study:

• To examine associations between demographic, socioeconomic, and EMS agency factors and APOT.
• To identify disparities in ambulance offload delays.
• To investigate factors contributing to prolonged APOT.

Main Methods:

• Retrospective cohort study using California EMS data (Jan 2021-June 2023).
• Included 5.9 million ambulance offloads across 34 local EMS agencies (LEMSAs).
• Assessed 30 community and LEMSA factors, analyzing associations with weighted mean APOT using linear regression and LASSO penalization.

Main Results:

• The proportion of Black residents was most significantly associated with longer APOT.
• A 3.3% increase in Black residents correlated with a 17.4-minute unadjusted increase in APOT, remaining significant (11.75 minutes) after adjustments.
• Other factors associated with APOT included older age (≥65 years) and total offloads.

Conclusions:

• Higher proportions of Black residents are linked to significantly longer ambulance patient offload times.
• APOT may represent a critical component of health disparities within emergency care.
• Findings underscore the need to address systemic factors contributing to unequal emergency care delivery.