急性中风护理方面城乡差距不断扩大。
Progressive rural-urban disparity in acute stroke care.
作者信息
Gonzales Sergio, Mullen Michael T, Skolarus Lesli, Thibault Dylan P, Udoeyo Uduak, Willis Allison W
机构信息
From the Leonard Davis Institute of Health Economics (S.G., M.T.M., A.W.W.), Center for Clinical Epidemiology and Biostatistics (D.P.T., A.W.W.), and Department of Biostatistics and Epidemiology (A.W.W.), University of Pennsylvania; Department of Neurology (S.G., M.T.M., D.P.T., A.W.W.), University of Pennsylvania School of Medicine, Philadelphia; Department of Neurology (L.S., A.W.W.), University of Michigan, Ann Arbor; and Dorsnsife School of Public Health (U.U.), Drexel University, Philadelphia, PA.
出版信息
Neurology. 2017 Jan 31;88(5):441-448. doi: 10.1212/WNL.0000000000003562. Epub 2017 Jan 4.
OBJECTIVE
To explore rural-urban differences and trends in tissue plasminogen activator (tPA) utilization among acute ischemic stroke (AIS) patients and examine the association between primary stroke center (PSC) growth and geographic disparity in tPA use.
METHODS
We used hospital discharge data from the National Inpatient Sample (NIS) from 2000 to 2010 and indicators of tPA utilization and describe temporal trends in geographic disparities in AIS care during PSC growth. The Gini coefficient was used to quantify rural-urban inequity in tPA use at the state level (from 0% to 100% of maximum potential rural-urban inequity) in tPA use.
RESULTS
Of 914,500 cases of AIS between 2001 and 2010, 2.3% (n = 21, 190) received tPA. The rural-urban disparity in tPA worsened: tPA use in urban hospitals quadrupled (1.17%-4.87%) compared to rural hospitals (0.87%-1.59%). Of 33 states with NIS data, 15 reached at least 75% of the maximum rural-urban inequality from 2004 to 2010.
CONCLUSIONS
Geographic disparities in tPA use for AIS are increasing. Greater understanding of the effectors of tPA utilization is necessary to ensure that access to tPA treatment is equitable for all communities in the United States.
目的
探讨急性缺血性卒中（AIS）患者在组织型纤溶酶原激活剂（tPA）使用方面的城乡差异及趋势，并研究初级卒中中心（PSC）的发展与tPA使用的地理差异之间的关联。
方法
我们使用了2000年至2010年国家住院样本（NIS）的医院出院数据以及tPA使用指标，描述了PSC发展期间AIS治疗地理差异的时间趋势。基尼系数用于量化州一级tPA使用方面的城乡不平等程度（从最大潜在城乡不平等的0%到100%）。
结果
在2001年至2010年的914,500例AIS病例中，2.3%（n = 21,190）接受了tPA治疗。tPA使用的城乡差距恶化：与农村医院（0.87% - 1.59%）相比，城市医院的tPA使用量增长了四倍（1.17% - 4.87%）。在有NIS数据的33个州中，15个州在2004年至2010年期间达到了最大城乡不平等的至少75%。
结论
AIS患者tPA使用的地理差异正在增加。有必要更深入了解tPA使用的影响因素，以确保美国所有社区都能公平获得tPA治疗。
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