Geographic Disparities in Stroke Outcomes and Service Access: A Prospective Observational Study

Area of Science:

• Neurology
• Public Health
• Health Services Research

Background:

• International studies indicate nonurban hospital patients have reduced access to stroke interventions.
• Existing evidence on geographical disparities in stroke outcomes is conflicting and often relies on less robust data.
• This study addresses the need for high-quality, patient-level data to examine rural-urban differences in stroke care and outcomes in New Zealand.

Purpose of the Study:

• To investigate the association between hospital geography (nonurban vs. urban) and stroke patient outcomes in New Zealand.
• To assess access to best-practice stroke care interventions across different hospital settings.
• To utilize comprehensive, prospective, nationwide patient-level data for robust analysis.

Main Methods:

• Prospective, multicenter, nationally representative observational study of all 28 New Zealand acute stroke hospitals (18 nonurban).
• Inclusion of consecutive adult patients admitted with acute stroke between May and October 2018.
• Assessment of outcomes including functional status (modified Rankin Scale), quality of life, stroke events, and mortality at 3, 6, and 12 months, alongside access to interventions (thrombolysis, thrombectomy, stroke units, rehabilitation).

Main Results:

• Patients at nonurban hospitals experienced significantly greater disability (higher mRS scores) at 3, 6, and 12 months post-stroke.
• Higher rates of death, recurrent stroke, and vascular events were observed in patients treated at nonurban facilities.
• Access to key interventions like endovascular thrombectomy, acute stroke unit care, and rehabilitation services was substantially lower in nonurban settings.

Conclusions:

• Nonurban hospital management is associated with poorer stroke outcomes and reduced access to essential stroke care interventions.
• Significant disparities exist across the entire stroke care continuum for patients in nonurban areas.
• Prioritizing efforts to enhance access to high-quality stroke care in nonurban hospitals is crucial for health equity.