Florey Neuroscience Institutes, Heidelberg, Vic, Australia.
Int J Stroke. 2013 Apr;8(3):164-71. doi: 10.1111/j.1747-4949.2011.00717.x. Epub 2012 Feb 2.
Indigenous Australians have greater stroke mortality rates than non-Indigenous people (97% Indigenous Australians are aged <65 years). Quality of care in hospital is an important factor for avoiding death and disability. No national review of acute stroke care for Indigenous Australians is available.
We aimed to compare adherence with clinical processes and outcomes among Indigenous and non-Indigenous patients with acute stroke admitted to hospital.
Hospitals participating in the National Stroke Audit of acute services in 2009 that provided data for at least one Indigenous patient were included (n = 33, 37%). Differences in death/dependency (modified Rankin Score 3-6) at discharge were determined using two-level multivariate analysis adjusting for hospital site and patient variables. A matched subgroup analysis in those aged 18 to 64 years was also undertaken.
Among 1162 eligible patients (60% male; 18-64 years n = 305), 7% were Indigenous (18-64 years: 18%). Indigenous patients had a greater prevalence of stroke risk factors, e.g. diabetes, more had intracerebral hemorrhages (25% vs. 16% non-Indigenous, P = 0.05), and were less likely be treated in a stroke unit and receive timely allied health assessments than non-Indigenous patients. Indigenous patients aged 18-64 years had a threefold odds of dying or being dependent at discharge (Adjusted odds ratio = 3.09, 95% confidence interval = 1.07-8.95).
Australian Indigenous patients with stroke received a reduced quality of care in hospitals and experienced worse outcomes than non-Indigenous patients. Indigenous patients require the provision of evidence-based care to increase their opportunities for optimal health outcomes following stroke. Further research to explain the differences is needed.
澳大利亚原住民的中风死亡率高于非原住民（97%的澳大利亚原住民年龄<65 岁）。医院的护理质量是避免死亡和残疾的一个重要因素。目前尚无针对澳大利亚原住民急性中风护理的全国性审查。
我们旨在比较住院的急性中风原住民和非原住民患者的临床过程和结局的一致性。
纳入 2009 年参与国家急性服务中风审计的医院（n = 33，37%），这些医院提供了至少一名原住民患者的数据。使用两水平多变量分析调整医院地点和患者变量，确定出院时的死亡/依赖（改良 Rankin 评分 3-6）差异。还对年龄在 18 至 64 岁的患者进行了匹配亚组分析。
在 1162 名合格患者中（60%为男性；18-64 岁患者 n = 305），7%为原住民（18-64 岁：18%）。原住民患者中风风险因素的患病率更高，例如糖尿病，更多的患者患有脑出血（25%比非原住民患者的 16%，P = 0.05），且在中风病房接受治疗和及时获得联合健康评估的可能性低于非原住民患者。年龄在 18-64 岁的原住民患者出院时死亡或依赖的可能性是三倍（调整后的优势比=3.09，95%置信区间=1.07-8.95）。
澳大利亚原住民中风患者在医院接受的护理质量较低，结局比非原住民患者更差。原住民患者需要提供循证护理，以增加他们在中风后获得最佳健康结果的机会。需要进一步研究以解释这些差异。
