Rural-urban differences in functional outcomes after acute stroke therapy within the stroke belt

The Southeastern United States (US) has the highest stroke mortality rate in the country. A high proportion of its population lives in rural areas. Rural patients with stroke have worse outcomes than their urban counterparts. We compared 90-day modified Rankin Score (mRS) between patients living in urban versus rural areas who received endovascular intervention for acute stroke.

We performed a retrospective analysis of patients who received acute stroke therapy at a comprehensive stroke center in the Southeastern US from 2014 to 2018. Individuals were classified as rural or urban dwellers based on 2010 Rural-Urban Commuting Area Codes. Stepwise logistic regression models were performed using clinical and demographic characteristics to compare good (mRS 0-1) vs poor (mRS 2-6) functional outcomes between urban and rural patients.

232 patients were included (185 urban and 47 rural). Urban and rural groups had similar composition of age, gender, and proportion of African-Americans. Mean baseline NIH stroke scale was higher in rural patients (17.0 vs 14.8 respectively, p-value=0.03.). Our model for poor functional outcome at 90-days revealed only older age as a significant risk factor (OR 0.97, 95% CI 0.95-0.99).

Our study found that for patients receiving acute therapy for ischemic stroke, there were no significant differences in functional outcome between urban versus rural patients. Only older age predicted poor functional outcome at 90 days. Our study demonstrates that patients from rural areas may not have worse mortality rates or poor outcomes and can recover similarly to those from urban areas.