Supplementary Material for: Incidence and associated factors of pre-hospital care-seeking delay in people with acute ischemic stroke: a systematic review and meta-analysis

Background: Despite decades of educational efforts, patients with acute ischemic stroke (AIS) remain delayed in seeking medical care, which becomes the greatest obstacle to the successful management of the condition.
Objective: To systematically explore the incidence and influencing factors of pre-hospital care-seeking delay in acute ischemic stroke patients.
Methods: We systematically searched the PubMed, Embase, Cochrane Library, Web of Science, and Cumulative Index to Nursing and Allied Health Literature from database inception to September 30, 2023. Meta-analysis was conducted using the Stata 15.0 software package. The pooled incidence was calculated using a random-effects model. The quality of studies reporting incidence data was assessed using Joanna Briggs Institute's Critical Appraisal Checklist and Newcastle-Ottawa Scale. Subgroup analyses were performed according to study location, country income, recruitment date, and age.
Results: Finally, 30 related articles were included, involving a total of 287,102 people. The estimated incidence of pre-hospital care-seeking delay was 68%,and there were differences in this incidence in different countries (P= 0.035). Meta-analysis results showed that the delay rate was highest in low-income countries (85%) and lowest in high-income countries (62%). Patients who live farther from hospitals, have a lower level of education, diabetes, hyperlipidemia, or a history of stroke are more likely to experience delays (all P <0.05). Conversely, those who can recognize stroke symptom , perceive the severity of early symptom, understand thrombolysis treatment, atrial fibrillation, consciousness disturbance, visual disturbance, and symptom score at admission, Emergency Medical Services use, and immediate help-seeking have a lower risk of delay (all P < 0.05).
Conclusions: Pre-hospital care-seeking delays are common among patients with AIS, especially in low-income countries. To reduce delays, it is crucial to increase public awareness of stroke symptoms, improve education levels, and optimize healthcare accessibility.