Impact of Rurality and Geographical Accessibility on Stroke Care and Outcomes

Area of Science:

• Public Health
• Neurology
• Health Services Research

Background:

• Equitable healthcare for rural stroke patients faces challenges, often linked to reduced interventions and poorer outcomes.
• Geographic classifications significantly influence stroke care delivery and patient results in Scotland.
• Previous studies often used broad urban/rural or accessible/remote categorizations, potentially masking important variations.

Purpose of the Study:

• To assess how distinct patient-related geographic classifications impact stroke care and outcomes in Scotland.
• To compare the effectiveness of binary versus a six-category geographic classification system.
• To identify specific rural subgroups that may experience disparities in stroke care.

Main Methods:

• A population-level data-linkage study of ischemic stroke patients admitted between 2010 and 2018 in Scotland.
• Utilized a six-category geographic classification (large urban, other urban, accessible small towns, remote small towns, accessible rural, remote rural).
• Analyzed process outcomes (stroke care bundle, thrombolysis) and clinical outcomes (30-day discharge, 90-day home time, 1-year mortality).

Main Results:

• A six-category classification revealed significant differences missed by binary classifications.
• Patients in accessible rural areas were more likely to receive a complete stroke care bundle (aOR 1.21).
• Patients in remote rural areas were less likely to receive a complete stroke care bundle (aOR 0.85) but had better 30-day discharge rates (aSDR 1.11) and 90-day home time (aIRR 1.03).

Conclusions:

• Accurate geographic classification, considering both rurality and accessibility, is vital for understanding stroke care disparities.
• While remote rural patients received less stroke care bundle achievement, this did not correlate with poorer overall outcomes.
• Tailored healthcare strategies considering specific geographic contexts are necessary to ensure equitable stroke care for all populations.