Rural Stroke Patients Have Higher Mortality: An Improvement Opportunity for Rural Emergency Medical Services Systems.
Rural Stroke Patients Have Higher Mortality: An Improvement Opportunity for Rural Emergency Medical Services Systems.
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农村中风患者的死亡率更高：农村紧急医疗服务系统的改进机会。
DOI：
10.1111/jrh.12502
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Mohr NM
中科院分区：
文献类型：
--
作者：
Georgakakos PK;Swanson MB;Ahmed A;Mohr NM
早期识别和及时的院前救治是急性卒中治疗的基石。农村居民比城市居民更难获得中风服务。这项研究的目的是(1)描述美国城乡卒中死亡率的趋势，(2)确定与城乡卒中病死率差异相关的可能因素。这项研究是一项全国性的卒中入院回顾队列研究。主要接触是患者住所的稀有。主要结果是在医院遭遇死亡。次要结果是出院到护理机构或家庭保健中心。单变量和多变量Logistic回归估计了卒中受试者中按受试者农村分类的死亡率。农村卒中患者的死亡率高于非农村患者(18.6%对16.9%)。在调整了患者和医院因素后，患者的农村与死亡率的增加相关(AOR=1.11；95%可信区间1.06-1.15；P<；0.001)。对于出院回家的次要结果，农村中风就诊比非农村中风就诊更不可能出院到护理机构(AOR0.94；95%CI 0.91-0.97；P<；0.001)。在调整溶栓药物的使用和转移状态后，结果是相似的。农村中风患者的死亡率高于城市中风患者，这可能是因为他们慢性病负担更重，健康素养较低，获得及时院前护理的机会较少。紧急医疗服务(EMS)系统可能有机会帮助患者和临床医生提高对中风的认识，并建立响应模式以加快紧急护理。
Early recognition and prompt pre-hospital 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 is 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. Primary exposure was rurality of patient’s residence. Primary outcome was hospital encounter death. Secondary outcome was discharge to a care facility or home health care. Univariable and multivariable logistic regression estimated the odds of mortality by subject rurality among stroke subjects. Rural stroke subjects had higher mortality than non-rural counterparts (18.6% rural vs. 16.9% non-rural). 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 < 0.001). For the secondary outcome of discharge to home, rural stroke visits were less likely to be discharged to a care facility than non-rural stroke visits (aOR 0.94; 95%CI 0.91 – 0.97; P < 0.001). Results were similar after adjusting for thrombolytics administration and transfer status. Rural stroke patients have higher mortality than urban counterparts likely due to their increased burden of chronic disease, lower health literacy and reduced access to prompt pre-hospital care. There may be an opportunity for emergency medical services (EMS) systems to assist in increase stroke awareness for both patients and clinicians and establish response patterns to expedite emergency care.
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影响因子：
8.3
作者：
Oostema, J. Adam;Konen, John;Reeves, Mathew J.
通讯作者：
Reeves, Mathew J.
影响因子：
9.9
作者：
Gonzales, Sergio;Mullen, Michael T.;Willis, Allison W.
通讯作者：
Willis, Allison W.
DOI：
10.1161/circoutcomes.118.004973
发表时间：
2019-02-01
影响因子：
6.9
作者：
Kapral, Moira K.;Austin, Peter C.;Tu, Jack, V
通讯作者：
Tu, Jack, V
影响因子：
8.3
作者：
Kothari, R;Sauerbeck, L;Liu, TP
通讯作者：
Liu, TP
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN