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Updated: Jun 15, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Stroke but no hospital admission: Lost opportunity for whom?
Carine Milcent1, Hanta Ramaroson2, Fleur Maury3
1Center for National Scientific Research - CNRS, Paris School of Economics - PSE, Health Economics, Econometrics, Paris, France.
Insights
COVID-19 restrictions impacted healthcare access for ischemic stroke patients in France. Disadvantaged groups and seniors faced significant delays in seeking care, highlighting persistent healthcare accessibility gaps.
Area of Science:
- Public Health
- Health Economics
- Epidemiology
Background:
- The COVID-19 pandemic prompted stringent government measures in France, significantly altering societal functions.
- Understanding the impact of these measures on healthcare access for critical conditions like ischemic stroke is crucial.
Purpose of the Study:
- To assess the effect of COVID-19 related policies on healthcare access for ischemic stroke patients in France during 2020.
- To identify disparities in healthcare-seeking behavior across different socioeconomic and demographic groups.
Main Methods:
- Retrospective analysis of a French national hospital discharge database (2019-2020) for stroke inpatients.
- Integration of socioeconomic data (income) to analyze disparities.
- Stratification of analysis into pre-pandemic, lockdown, transitional, and shutdown periods.
Main Results:
- Both affluent and disadvantaged populations showed reluctance to seek medical care during the lockdown, particularly in highly affected areas.
- Disadvantaged patients and seniors (over 75) experienced slower recovery of healthcare access rates compared to pre-pandemic levels.
- A notable gap in healthcare accessibility persisted, especially for socioeconomically disadvantaged groups, even after restrictions eased.
Conclusions:
- COVID-19 policies created significant barriers to healthcare access for ischemic stroke patients, disproportionately affecting vulnerable populations.
- Socioeconomic status and age are critical determinants of healthcare access during public health crises.
- Targeted interventions are needed to address persistent healthcare disparities exacerbated by the pandemic.
Abstract:
To counter the spread of COVID-19, the French government imposed several stringent social and political measures across its entire population. We hereto assess the impact of these political decisions on healthcare access in 2020, focusing on patients who suffered from an ischemic stroke. We divide our analysis into four distinct periods: the pre-COVID-19 pandemic period, the lockdown period, the "in-between" or transitional period, and the shutdown period. Our methodology involves utilizing a retrospective dataset spanning 2019-2020, an exhaustive French national hospital discharge diagnosis database for stroke inpatients, integrated with income information from the reference year of 2019. The results reveal that the most affluent were more likely to forgo medical care, particularly in heavily affected areas. Moreover, the most disadvantaged exhibited even greater reluctance to seek care, especially in the most severely impacted regions. The data suggest a loss of opportunity for less severely affected patients to benefit from healthcares during this lockdown period, regardless of demographic, location, and socioeconomic determinants. Furthermore, our analysis reveals a notable discrepancy in healthcare-seeking behavior, with less affluent patients and seniors (over 75 years old) experiencing slower rates of return to healthcare access compared to pre-pandemic levels. This highlights a persistent gap in healthcare accessibility, particularly among socioeconomically disadvantaged groups, despite the easing of COVID-19 restrictions.
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