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Impact of socioeconomic status on presentation, care quality and outcomes of patients attended by emergency medical services for dyspnoea: a population-based cohort study
  1. Jennifer Zhou1,
  2. Emily Nehme2,3,
  3. Luke Dawson1,3,
  4. Jason Bloom1,3,
  5. Natasha Smallwood4,
  6. Daniel Okyere2,
  7. Shelley Cox5,
  8. David Anderson2,6,
  9. Karen Smith3,7,
  10. Dion Stub1,3,
  11. Ziad Nehme2,3,
  12. David Kaye1,8
  1. 1 Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
  2. 2 Centre for Research & Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
  3. 3 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  4. 4 Respiratory Medicine, Alfred Hospital, Melbourne, Victoria, Australia
  5. 5 Ambulance Victoria, Doncaster, Victoria, Australia
  6. 6 Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia
  7. 7 Silverchain Group, Melbourne, Victoria, Australia
  8. 8 Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  1. Correspondence to Dr David Kaye, Cardiology, Alfred Hospital, Melbourne, VIC 3004, Australia; david.kaye{at}


Background Low socioeconomic status (SES) has been linked to poor outcomes in many conditions. It is unknown whether these disparities extend to individuals presenting with dyspnoea. We aimed to evaluate the relationship between SES and incidence, care quality and outcomes among patients attended by emergency medical services (EMS) for dyspnoea.

Methods This population-based cohort study included consecutive patients attended by EMS for dyspnoea between 1 January 2015 and 30 June 2019 in Victoria, Australia. Data were obtained from individually linked ambulance, hospital and mortality datasets. Patients were stratified into SES quintiles using a composite census-derived index.

Results A total of 262 412 patients were included. There was a stepwise increase in the age-adjusted incidence of EMS attendance for dyspnoea with increasing socioeconomic disadvantage (lowest SES quintile 2269 versus highest quintile 889 per 100 000 person years, ptrend<0.001). Patients of lower SES were younger and more comorbid, more likely to be from regional Victoria or of Aboriginal or Torres Strait Islander heritage and had higher rates of respiratory distress. Despite this, lower SES groups were less frequently assigned a high acuity EMS transport or emergency department (ED) triage category and less frequently transported to tertiary centres or hospitals with intensive care unit facilities. In multivariable models, lower SES was independently associated with lower acuity EMS and ED triage, ED length of stay>4 hours and increased 30-day EMS reattendance and mortality.

Conclusion Lower SES was associated with a higher incidence of EMS attendances for dyspnoea and disparities in several metrics of care and clinical outcomes.


Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • ZN and DK are joint senior authors.

  • Twitter @drjenniferzhou

  • Contributors JZ, EN, KS, ZN, DS and DK contributed to the conception and design of the research. JZ and EN performed the data analysis and interpretation. DS, ZN and DK provided supervision for the project. JZ wrote the manuscript draft and is responsible for the overall content as guarantor. All authors contributed to critical revision of the manuscript and approval of the manuscript to be published.

  • Funding This study was supported by Ambulance Victoria and the Department of Cardiology, Alfred Health. EN is supported by National Health and Medical Research Council (NHMRC) postgraduate scholarship (GNT2003449). NS is supported by a Windermere Foundation Fellowship and NHMRC Investigator Fellowship (GNT1196061). DS is supported by a National Heart Foundation Fellowship (105739) and NHMRC Investigator Grant (GNT2017609). ZN is supported by a NHMRC Early Career Fellowship (1146809). DK is supported by a NHMRC Investigator Grant (GNT2008017).

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  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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