Rehabilitation Outcomes Research Center, North Florida/South Georgia Veterans Health System, Gainesville, Florida 32608–1197, USA.
J Rural Health. 2012 Summer;28(3):242-7. doi: 10.1111/j.1748-0361.2011.00397.x. Epub 2011 Oct 21.
To assess the association between Veterans affairs (VA) stroke patients' poststroke rehabilitation utilization and their residential settings by using 2 common rural-urban taxonomies.
This retrospective study included all VA stroke inpatients in 2001 and 2002. Rehabilitation utilization referred to rehabilitation therapy received 12-months poststroke hospitalization. Patients' urban, rural, or isolated/highly rural status was determined using the rural-urban commuting areas (RUCA) and VA rural urban (VARU) definitions based on patient residential ZIP code. Logistic regression models were fit for the rehabilitation outcome, adjusting for potential risk factors.
Among the 8,296 stroke patients, 69.6%/61.1% were categorized as urban, 21.3%/37.5% as rural, and 9.1%/1.4% as isolated/highly rural by the RUCA/VARU definitions, respectively. Compared with their urban counterparts, the rural and/or isolated/highly rural patients were significantly more likely to be older, white, married, living further from the VA hospitals, not hospitalized for stroke directly from home, and not intubated. Compared with the rural patients, odds of receiving rehabilitation therapy were 1.2 times (RUCA) and 1.1 times (VARU) by the urban patients, and 0.53 times (VARU only) by the highly rural patients, after risk adjustment. The above comparisons were significant at P < .05.
With both taxonomies, the rural patients were less likely to receive postacute stroke rehabilitant therapy than their urban counterparts. With the VARU, the highly rural patients were less likely to receive rehabilitation care than their rural counterparts. Different taxonomy may lead to different rural-urban classification yields and different yields may lead to different outcomes and conclusions.
利用两种常见的城乡分类方法，评估退伍军人事务部（VA）中风患者中风后康复利用与居住环境的关系。
本回顾性研究纳入了 2001 年和 2002 年所有 VA 中风住院患者。康复利用是指中风后 12 个月住院期间接受的康复治疗。根据患者居住的邮政编码，使用城乡通勤区（RUCA）和 VA 城乡（VARU）定义确定患者的城市、农村或孤立/高度农村状态。基于逻辑回归模型，调整潜在的风险因素后，对康复结果进行拟合。
在 8296 例中风患者中，RUCA/VARU 定义分别将 69.6%/61.1%归类为城市，21.3%/37.5%归类为农村，9.1%/1.4%归类为孤立/高度农村。与城市患者相比，农村和/或孤立/高度农村患者年龄更大、更可能为白人、已婚、居住离 VA 医院更远、不是直接从家中住院治疗中风、未插管。与农村患者相比，城市患者接受康复治疗的可能性分别高出 1.2 倍（RUCA）和 1.1 倍（VARU），而高度农村患者仅为 0.53 倍（仅 VARU），经风险调整后。上述比较在 P <.05 时具有统计学意义。
使用这两种分类法，农村患者接受急性后期中风康复治疗的可能性均低于城市患者。使用 VARU 时，高度农村患者接受康复护理的可能性低于农村患者。不同的分类法可能导致不同的城乡分类结果，而不同的结果可能导致不同的结论。
