Julius Koifman1, Ruth Hall2, Shudong Li3, Melissa Stamplecoski4, Jiming Fang5, Alexandra P Saltman6, Moira K Kapral7. 1. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: 8jyk@queensu.ca. 2. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: ruth.hall@ices.on.ca. 3. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: shudong.li@ices.on.ca. 4. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: melissa.stamplecoski@ices.on.ca. 5. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: jiming.fang@ices.on.ca. 6. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: alexandra.saltman@gmail.com. 7. Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada. Electronic address: moira.kapral@uhn.ca.
Abstract
BACKGROUND: Little is known about stroke care and outcomes in those residing in rural compared to urban areas. METHODS: We conducted a cohort study on a population-based sample of patients with stroke or transient ischemic attack seen at 153 acute care hospitals in the province of Ontario, Canada, between April 1, 2008 and March 31, 2011. Based on their primary residence, patients were categorized as residing in a rural (population<10,000), medium urban (population 10,000-99,999) or large urban (population≥100,000) area. In the study sample of 15,713, we compared processes of stroke care (use of thrombolysis, stroke unit care, investigations, consultations and treatments) and outcomes (30-day mortality, disability at discharge) in those from rural and urban areas, with multivariable models constructed to evaluate the association between rural residence and outcomes after adjustment for potential confounders. RESULTS: Patients from rural areas were less likely than those from urban areas to receive stroke unit care, brain imaging within 24 h, carotid imaging, and consultations from neurologists, physiotherapists, occupational therapists and speech language pathologists, and were less likely to be transferred to inpatient rehabilitation facilities. Use of antithrombotic agents and lipid lowering therapy was similar in rural and urban residents, as was disability at discharge. There was a trend toward higher 30-day mortality in rural compared to urban residents (adjusted hazard ratio 1.14; 95% confidence interval 0.99-1.32). CONCLUSION: Rural residence is associated with lower use of key stroke care interventions after stroke. Future work should focus on developing interventions to address gaps in stroke care in rural areas.
BACKGROUND: Little is known about stroke care and outcomes in those residing in rural compared to urban areas. METHODS: We conducted a cohort study on a population-based sample of patients with stroke or transient ischemic attack seen at 153 acute care hospitals in the province of Ontario, Canada, between April 1, 2008 and March 31, 2011. Based on their primary residence, patients were categorized as residing in a rural (population<10,000), medium urban (population 10,000-99,999) or large urban (population≥100,000) area. In the study sample of 15,713, we compared processes of stroke care (use of thrombolysis, stroke unit care, investigations, consultations and treatments) and outcomes (30-day mortality, disability at discharge) in those from rural and urban areas, with multivariable models constructed to evaluate the association between rural residence and outcomes after adjustment for potential confounders. RESULTS:Patients from rural areas were less likely than those from urban areas to receive stroke unit care, brain imaging within 24 h, carotid imaging, and consultations from neurologists, physiotherapists, occupational therapists and speech language pathologists, and were less likely to be transferred to inpatient rehabilitation facilities. Use of antithrombotic agents and lipid lowering therapy was similar in rural and urban residents, as was disability at discharge. There was a trend toward higher 30-day mortality in rural compared to urban residents (adjusted hazard ratio 1.14; 95% confidence interval 0.99-1.32). CONCLUSION: Rural residence is associated with lower use of key stroke care interventions after stroke. Future work should focus on developing interventions to address gaps in stroke care in rural areas.
Authors: Eméfah C Loccoh; Karen E Joynt Maddox; Yun Wang; Dhruv S Kazi; Robert W Yeh; Rishi K Wadhera Journal: J Am Coll Cardiol Date: 2022-01-25 Impact factor: 24.094
Authors: Tali Elfassy; Leslie Grasset; M Maria Glymour; Samuel Swift; Lanyu Zhang; George Howard; Virginia J Howard; Matthew Flaherty; Tatjana Rundek; Theresa L Osypuk; Adina Zeki Al Hazzouri Journal: Stroke Date: 2019-04 Impact factor: 7.914
Authors: George Howard; Dawn O Kleindorfer; Mary Cushman; D Leann Long; Adam Jasne; Suzanne E Judd; John C Higginbotham; Virginia J Howard Journal: Stroke Date: 2017-06-16 Impact factor: 7.914
Authors: Richard Fleet; Sylvain Bussières; Fatoumata Korika Tounkara; Stéphane Turcotte; France Légaré; Jeff Plant; Julien Poitras; Patrick M Archambault; Gilles Dupuis Journal: PLoS One Date: 2018-01-31 Impact factor: 3.240