Impact of social deprivation on access to care delay in patients with acute myocardial infarction: a French registry-based study

Prompt diagnosis to initiate appropriate reperfusion treatment is crucial for improving clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The time taken by STEMI patients to seek care, identified as patient delay, often exceeds recommended guidelines. Socially disadvantaged patients with STEMI face social and health inequalities that negatively impact their prognosis. However, the influence of socioeconomic status, specifically through multidimensional deprivation indices, on patient delays remains unexplored. All adult patients with STEMI diagnosed by emergency physicians within 24 h of symptom onset and treated between January 1st, 2017, and December 31st, 2018, in any of the emergency medical services, medical intensive care units, emergency departments, and catheterization laboratories in the French Aquitaine region were included. Patients were identified in the exhaustive French Aquitaine cardiovascular registries. Association between social deprivation ecological index (ranging from − 3.3 to + 2.5) and patient delay (pain-to-first medical contact time) was analyzed using linear mixed model. The causal model was constructed using a directed acyclic graph to choose confounders, guided by pre-selected theoretical factors. The study included 2,733 STEMI patients. The use of mobile intensive care unit transport decreased with increasing levels of disadvantage, from 70.9% for the most advantaged patients to 50.9% for the most disadvantaged patients ( p < 0.001). All median acute care management times were longer for the most disadvantaged compared to the most advantaged patients. Living in a socially disadvantaged commune was associated with longer delays in accessing care (n = 2,139, exp(β) = 1.09, 95%CI [1.04–1.16]), with 10 min lost per 1-point increase in the deprivation index. Socially disadvantaged patients face longer patient delays. Research on barriers to healthcare access, particularly psychosocial determinants of health and contextual barriers, is essential for implementing effective healthcare programs.