Racial Inequities Across Rural Strata in Acute Stroke Care and In-Hospital Mortality: National Trends Over 6 Years.
Racial Inequities Across Rural Strata in Acute Stroke Care and In-Hospital Mortality: National Trends Over 6 Years.
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DOI：
10.1161/strokeaha.121.035006
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发表时间：
2022-05
期刊：
影响因子：
8.3
通讯作者：
Maddox, Karen E. Joynt
中科院分区：
文献类型：
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作者：
Hammond, Gmerice;Waken, R. J.;Johnson, Daniel Y.;Towfighi, Amytis;Maddox, Karen E. Joynt
在中风的结果中存在明显的种族和城乡不平等。本研究的目的是确定中风治疗和住院死亡率的种族不平等趋势是否有最近的变化，以及农村阶层的种族不平等是否不同。回顾性分析了2012-2017年国家住院患者样本中，在美国急性护理医院住院的主要出院诊断为卒中的黑人和白色患者（未加权N= 652，836）。农村居民按县分为城市、镇或农村。主要结局是急性缺血性卒中（AIS）患者的静脉溶栓（IVT）和血管内治疗（EVT）使用情况，以及所有卒中患者的住院死亡率。Logistic回归模型对每个结果进行调整，包括年龄、合并症、主要支付者和邮政编码中位数收入。样本中53%为女性，81%为白色，19%为黑人。与白色城市患者相比，农村地区黑人患者接受IVT（校正比值比[aOR] 0.43，95%置信区间[CI] 0.37-0.50）和EVT（aOR 0.60 [0.46-0.78]）的比值最低。与白色/城市患者相比，黑人农村患者在卒中后出院回家的可能性最小（aOR 0.79 [0.75-0.83]），与白人相比，城市-农村范围内的黑人患者也是如此。来自城市地区的黑人患者的死亡率低于来自城市地区的白色患者（aOR 0.87 [0.84-0.91]），而来自农村地区的白色患者（aOR 1.14 [1.10-1.19]）的死亡率是所有人群中最高的。生活在农村地区的黑人患者是一个特别高风险的群体，他们难以获得先进的中风护理和受损的中风后功能状态。农村白色患者的住院死亡率最高。需要临床和政策干预来改善中风护理和结果的可及性并减少不平等。
There are glaring racial and rural-urban inequities in stroke outcomes. The objective of this study was to determine whether there were recent changes to trends in racial inequities in stroke treatment and in-hospital mortality, and whether racial inequities differed across rural strata. Retrospective analysis of Black and white patients >18 years old admitted to U.S. acute-care hospitals with a primary discharge diagnosis of stroke (unweighted N=652,836) from the National Inpatient Sample from 2012–2017. Rural residence was classified by county as urban, town, or rural. The primary outcomes were intravenous thrombolysis (IVT) and endovascular therapy (EVT) use among patients with acute ischemic stroke (AIS), and in-hospital mortality for all stroke patients. Logistic regression models were run for each outcome adjusting for age, comorbidities, primary payer, and ZIP code median income. The sample was 53% female, 81% White and 19% Black. Black patients from rural areas had the lowest odds of receiving IVT (adjusted odds ratio [aOR] 0.43, 95% confidence interval [CI] 0.37–0.50) and EVT (aOR 0.60 [0.46–0.78]), compared to White urban patients. Black rural patients were the least likely to be discharged home after a stroke compared to white/urban patients (aOR 0.79 [0.75–0.83]), this was true for Black patients across the urban-rural spectrum when compared to whites. Black patients from urban areas had lower mortality than white patients from urban areas (aOR 0.87 [0.84–0.91]), while white patients from rural areas (aOR 1.14 [1.10–1.19]) had the highest mortality of all groups. Black patients living in rural areas represent a particularly high-risk group for poor access to advanced stroke care and impaired post-stroke functional status. Rural white patients have the highest in-hospital mortality. Clinical and policy interventions are needed to improve access and reduce inequities in stroke care and outcomes.