Stroke outcomes in Northern Scotland: does rurality really matter?

Area of Science:

• Public Health
• Neurology
• Rural Health

Background:

• Stroke is a leading cause of death and disability in Scotland.
• Rural populations may experience poorer health outcomes due to accessibility issues.
• Limited research exists on stroke care and outcomes in remote and rural settings.

Purpose of the Study:

• To examine the incidence and outcomes of first-ever stroke in the Highlands and Islands of Scotland.
• To investigate if remoteness and rurality impact stroke care and patient outcomes.
• To compare stroke care and outcomes between remote rural and urban/accessible settlements.

Main Methods:

• Prospective, community-based, observational survey of first-ever stroke patients over 12 months.
• Data collection on functional limitation and service provision at 1, 3, and 6 months post-stroke.
• Settlements categorized as urban/accessible, remote rural, and very remote using the Scottish Household Survey.

Main Results:

• 85 patients included in the final dataset; remote rural and very remote patients were over-represented.
• Likelihood of returning home from acute hospitals was not related to settlement category.
• Patients in remote rural areas were more likely to be admitted to and remain in community hospitals at 6 months.
• Two-thirds of patients experienced some disability; one-third remained independent.
• Barthel Index scores improved over time, indicating reduced disability.
• Service uptake was similar across all settlement categories, with low overall utilization, particularly for social-support and stroke-specific services.

Conclusions:

• Low reported stroke incidence may be due to various factors including death, diagnostic uncertainty, or under-reporting.
• Higher community hospital admission in remote rural areas may reflect service availability or stroke severity.
• Low uptake of rehabilitation and support services suggests an unmet need, impacting functional outcomes across all areas.
• Patients in remote and rural Scotland do not appear disadvantaged in stroke outcomes or service utilization compared to urban counterparts.
• Functional outcomes for stroke patients could be enhanced in all settlement categories.