Geographic Disparities in Stroke Outcomes and Service Access: A Prospective Observational Study

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dc.citation.issue4
dc.citation.volume99
dc.contributor.authorThompson SG
dc.contributor.authorBarber PA
dc.contributor.authorGommans JH
dc.contributor.authorCadilhac DA
dc.contributor.authorDavis A
dc.contributor.authorFink JN
dc.contributor.authorHarwood M
dc.contributor.authorLevack W
dc.contributor.authorMcNaughton HK
dc.contributor.authorFeigin VL
dc.contributor.authorAbernethy V
dc.contributor.authorGirvan J
dc.contributor.authorKim J
dc.contributor.authorDenison H
dc.contributor.authorCorbin M
dc.contributor.authorWilson A
dc.contributor.authorDouwes J
dc.contributor.authorRanta A
dc.coverage.spatialUnited States
dc.date.accessioned2023-06-21T21:29:01Z
dc.date.available2022-05-27
dc.date.available2022-03-01
dc.date.available2023-06-21T21:29:01Z
dc.date.issued2022-07-26
dc.description© 2022 The Author(s)
dc.description.abstractBACKGROUND AND OBJECTIVE: International evidence shows that patients treated at non-urban hospitals experience poorer access to key stroke interventions. Evidence whether this results in poorer outcomes is conflicting and generally based on administrative or voluntary registry data. The aim of this study was to use prospective high-quality comprehensive nationwide patient level data to investigate the association between hospital geography and stroke patient outcomes and access to best practice stroke care in New Zealand. METHODS: This is a prospective, multi-centre, nationally representative observational study involving all 28 New Zealand acute stroke hospitals (18 non-urban), and affiliated rehabilitation and community services. Consecutive adults admitted to the hospital with acute stroke between 1 May and 31 October 2018 were captured. Outcomes included functional outcome (modified Rankin Scale (mRS) shift analysis), functional independence (mRS scores 0-2), quality of life (EQ5D-3L), stroke/vascular events, and death at 3, 6, and 12 months and proportion accessing thrombolysis, thrombectomy, stroke units, key investigations, secondary prevention, and inpatient/community rehabilitation. Results were adjusted for age, sex, ethnicity, stroke severity/type, co-morbidities, baseline function, and differences in baseline characteristics. RESULTS: Overall, 2,379 patients were eligible (mean (standard deviation) age 75 (13.7); 51.2% male; 1,430 urban; 949 non-urban). Patients treated at non-urban hospitals were more likely to score in a higher mRS category (greater disability) at three (aOR=1.28, 1.07-1.53), six (aOR=1.33, 1.07-1.65) and twelve months (aOR=1.31, 1.06-1.62) and were more likely to have died (aOR=1.57, 1.17-2.12) or experienced recurrent stroke and vascular events at 12 months (aOR=1.94, 1.14-3.29 and aOR=1.65, 1.09-2.52). Fewer non-urban patients received recommended stroke interventions including endovascular thrombectomy (aOR=0.25, 95% confidence interval 0.13-0.49), acute stroke unit care (aOR=0.60, 0.49-0.73), antiplatelet prescriptions (aOR=0.72, 0.58-0.88), ≥60 minutes daily physical therapy (aOR=0.55, 0.40-0.77) and community rehabilitation (aOR=0.69, 0.56-0.84). DISCUSSION: Patients managed at non-urban hospitals experience poorer stroke outcomes and reduced access to key stroke interventions across the entire care continuum. Efforts to improve access to high quality stroke care in non-urban hospitals should be a priority.
dc.description.publication-statusPublished online
dc.format.extente414 - e426
dc.identifierhttps://www.ncbi.nlm.nih.gov/pubmed/35623890
dc.identifierWNL.0000000000200526
dc.identifier.citationNeurology, 2022, 99 (4), pp. e414 - e426
dc.identifier.doi10.1212/WNL.0000000000200526
dc.identifier.eissn1526-632X
dc.identifier.elements-id453526
dc.identifier.harvestedMassey_Dark
dc.languageeng
dc.publisherWolters Kluwer Health, Inc on behalf of the American Academy of Neurology
dc.relation.isPartOfNeurology
dc.rightsCC BY 4.0
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subject.anzsrc1103 Clinical Sciences
dc.subject.anzsrc1109 Neurosciences
dc.subject.anzsrc1702 Cognitive Sciences
dc.titleGeographic Disparities in Stroke Outcomes and Service Access: A Prospective Observational Study
dc.typeJournal article
pubs.notesNot known
pubs.organisational-group/Massey University
pubs.organisational-group/Massey University/College of Health
pubs.organisational-group/Massey University/College of Health/Research Centre for Hauora and Health
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