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Updated: May 29, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Rural-Urban Disparity in Postacute Care and 1-Year Outcomes After Ischemic Stroke
Shumei Man1, Jie-Lena Sun2, Brooke Alhanti2
1Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, OH (S.M., K.U.).
Stroke
|May 28, 2026
Summary
Rural stroke patients receive less rehabilitation and home time but have similar mortality compared to urban patients. Post-acute care disparities persist, requiring further efforts to ensure equitable outcomes for rural populations.
Area of Science:
- Stroke research
- Health services research
- Rural health
Background:
- Rural residents face higher stroke mortality rates than urban counterparts.
- Disparities in post-acute stroke care may exacerbate rural-urban gaps in mortality and disability.
- Understanding rural vs. urban post-acute stroke care is crucial for addressing health inequities.
Purpose of the Study:
- To compare post-acute care utilization and outcomes for stroke patients in rural versus urban settings.
- To investigate differences in discharge destinations and home-time after acute ischemic stroke.
- To analyze the impact of geographic location on stroke patient mortality and readmission rates.
Main Methods:
- Cohort study of Medicare beneficiaries (≥65 years) with acute ischemic stroke (2017-2022).
- Comparison of rural vs. urban hospital discharges using restricted mean home-time and Cox proportional hazards models.
- Adjustment for patient and hospital characteristics to analyze mortality and readmission.
Main Results:
- Rural patients were less likely discharged to inpatient rehabilitation (20.1% vs 25.1%) and more to skilled nursing facilities (24.5% vs 20.9%).
- Rural patients experienced less home-time overall (1.8 fewer days) and particularly when discharged to skilled nursing facilities or home.
- Overall mortality was comparable (aHR=1.01), but rural patients discharged home had higher mortality (aHR=1.11).
Conclusions:
- Rural stroke patients exhibit different post-acute care pathways, with reduced inpatient rehabilitation and home-time.
- Despite similar overall mortality, specific discharge pathways for rural patients may increase mortality risk.
- Equitable post-acute care delivery in rural areas requires targeted interventions to reduce disparities.
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