Objective: Our objective was to assess gender, ethnic, and access-to-c
are factors critical in delay time (DT) for presentation to the hospit
al for acute stroke. Background: Little information is available on th
e effect of gender, ethnicity, and access issues on DT. Design: Demogr
aphic, access-to-care, and DT information was obtained from emergency
department (ED) documentation of stroke patients admitted from July 19
95 through June 1997 at Hermann Hospital, Houston, TX. Univariate and
multivariate regression analyses were performed. Results: Of the 241 e
ligible patients, 126 were African American (AA), 82 were non-Hispanic
white (NHW), and 33 were Hispanic American (HA). Median DT from sympt
om onset to presentation to the ED was 222 minutes for AAs, 280 minute
s for HAs, and 230 minutes for NHWs. A multivariate regression model e
stimated DT to ED arrival decreased with ambulance transport (p = 0.00
3) and increased in patients with a primary care physician (p = 0.145)
and in women (p = 0.052). DT to see an ED physician after hospital ar
rival decreased with ambulance transport (p < 0.001), hemorrhage patie
nts (p = 0.006), and worse stroke severity (p = 0.038), and increased
in women (p = 0.041). DT to see a neurologist decreased with hemorrhag
e (p = 0.002) and ambulance arrival (p = 0.010). Neurologists saw pati
ents within 3 hours of symptom onset in 34% of NHWs, 28% of AAs, and 1
8% of HAs. Conclusion: Gender and access-to-care issues may be importa
nt determinants of delay in acute stroke care. Less than 20% of HAs pr
esented to the ED within 3 hours of symptom onset.