Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
University of Iowa Carver College of Medicine, Iowa City, Iowa.
J Rural Health. 2022 Jan;38(1):217-227. doi: 10.1111/jrh.12502. Epub 2020 Aug 5.
Early recognition and prompt prehospital care is a cornerstone of acute stroke treatment. Residents of rural areas have worse access to stroke services than urban residents. The purpose of this study was to (1) describe US trends in rural-urban stroke mortality and (2) identify possible factors associated with rural-urban stroke case-fatality disparities.
This study was a nationwide retrospective cohort study of stroke admissions. The primary exposure was rurality of patient's residence. The primary outcome was death during hospital encounter. The secondary outcome was discharge to a care facility or home healthcare. Univariable and multivariable logistic regressions estimated the odds of mortality by subject rurality among stroke subjects.
Rural stroke subjects had higher mortality than nonrural counterparts (18.6% rural vs 16.9% nonrural). After adjustment for patient and hospital factors, patient rurality was associated with increased odds of mortality (aOR = 1.11; 95% CI: 1.06-1.15; P < .001). For the secondary outcome of discharge to home, rural stroke subjects were less likely to be discharged to a care facility than nonrural stroke visits (aOR 0.94; 95% CI: 0.91-0.97; P < .001). Results were similar after adjusting for thrombolytics administration and transfer status.
Rural stroke patients have higher mortality than their urban counterparts likely due to their increased burden of chronic disease, lower health literacy, and reduced access to prompt prehospital care. There may be an opportunity for emergency medical services systems to assist in increasing stroke awareness for both patients and clinicians and to establish response patterns to expedite emergency care.
早期识别和及时的院前治疗是急性脑卒中治疗的基石。与城市居民相比，农村地区的居民获得脑卒中服务的机会较差。本研究的目的是：(1)描述美国农村-城市脑卒中死亡率的趋势；(2)确定与农村-城市脑卒中病死率差异相关的可能因素。
这是一项全国性的脑卒中住院患者回顾性队列研究。主要暴露因素是患者居住地的农村-城市分类。主要结局是住院期间死亡。次要结局是出院到护理机构或家庭医疗保健。单变量和多变量逻辑回归估计了脑卒中患者农村-城市分类与死亡率之间的比值比。
农村脑卒中患者的死亡率高于非农村脑卒中患者(18.6%农村比 16.9%非农村)。在调整了患者和医院因素后，患者的农村分类与死亡率增加的几率相关(aOR=1.11；95%CI：1.06-1.15；P<.001)。对于出院到家庭的次要结局，农村脑卒中患者出院到护理机构的可能性低于非农村脑卒中患者(aOR 0.94；95%CI：0.91-0.97；P<.001)。在调整溶栓治疗和转移状态后，结果相似。
农村脑卒中患者的死亡率高于城市患者，可能是由于他们患有更多的慢性疾病、健康素养较低，以及获得及时院前治疗的机会减少。急救医疗服务系统可能有机会帮助提高患者和临床医生对脑卒中的认识，并建立应对模式以加快紧急护理。
