Rural residents, American Indians travel farther to get certified stroke care


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The distance a stroke patient must travel to receive care at a certified stroke center varies by race, age, income, and insurance status, with the largest disparities between rural residents and American Indians, according to a combined analysis of U.S. census data and road maps published today in Stroke.

Treatment for , a blockage in an artery that supplies blood to the brain, restores blood flow to the brain. Rapid treatment is critical to reducing disability. Blood flow can be restored by administering drugs to break blood clots intravenously within 4.5 hours after the onset of stroke symptoms and, ideally, within one hour after arrival at the ‘hospital. All certified stroke centers offer treatment with medications that clot the clots, in addition to having medical professionals trained in stroke care and employ other measures to improve stroke care.

“Every day, those of us who deal with stroke face the reality that our desire to help everyone competes with the fact that millions of Americans cannot reach us in time,” said the lead author of the study, Akash Kansagra, MD, MS, associate professor of radiology, neurological surgery, and neurology at the University of Washington School of Medicine in St. Louis. Louis. “Stroke patients have a much higher chance of recovery if they can get to a stroke hospital quickly. The question we wanted to address was whether some Americans have to travel farther than others to receive the experience that can save them if they have a stroke. “

The 2019 American Heart Association / American Stroke Association guidelines recommend that stroke patients be transported by emergency medical services to the nearest stroke-capable hospital, in addition to using interactive video conferencing to provide care. of acute stroke, also known as “telictus”, for remote patients. configuration.

The American Heart Association and the Joint Commission are collaborating to provide hospitals with Stroke Act certification, primary stroke certification, thrombectomy-capable stroke certification, and complete stroke certification. in qualified hospitals.

The researchers used a public mapping service to compare the road distance with the nearest certified stroke center for each census tract (small geographic areas defined for the U.S. census) in the 48 contiguous states and the District of Columbia. For each census tranche, they collected data from the U.S. Census Bureau’s 2014-2018 U.S. Census Survey on age, race, ethnicity, health insurance status, income, and population density. The analysis covered 98% of all U.S. census tracts, which include more than 316 million people and more than 2,300 stroke-certified hospitals.

The researchers noted that the longest distances to stroke-certified centers were for people living in , rural areas with more elderly people, areas where fewer people had health insurance, census tracts with lower levels of family income and more representation of American Indians.


  • In rural areas, the census tracts with the oldest residents were further away from stroke centers, with a 1% increase in people aged 65 and over representing a distance of 0.31 miles greater to cover. . There was no clear relationship between the density of the elderly and the distance to stroke care in urban areas.
  • In both urban and rural areas, census tracts with a higher proportion of Native American residents were further away from certified stroke care centers, with a 1% increase in the proportion. of American Indians representing a distance of 0.06 miles greater to travel to urban areas. Distance 0.66 miles longer in rural areas.
  • In both urban and rural areas, the stretches with more uninsured people were further away from stroke centers; each 1% increase in the proportion of uninsured patients represented a difference of 0.01 mile more to travel to urban areas and a greater distance of 0.17 miles to rural areas.
  • The relationship between income and distance to a certified stroke center was reversed between urban and rural areas. In urban areas, each $ 10,000 increase in median household income represented a greater travel distance of 0.10 miles. In rural areas, each $ 10,000 increase in household income represented a shorter distance of 3.13 miles.

“Beyond the real differences in geographic proximity to stroke care between urban and non-urban areas, our analysis found notable differences in the associations between demographic characteristics and proximity to stroke care. in urban and rural settings, ”Kansagra said.

Kansagra said it was unclear why people over the age of 65 in rural areas were further away from certified stroke centers, “but the trend is disturbing. While stroke can occur at any age, the “Risk is higher in older adults. People who are more likely to have a stroke are also more likely to live away from a stroke hospital.”

The researchers said the finding that a higher income level meant a greater distance to stroke care in urban areas, but a shorter distance to resort to rural areas probably reflects the concentration of wealth in urban areas. suburban areas. “What surprised me was that there was no such reversal in areas where most residents did not have health insurance,” Kansagra said. “Regardless of where we looked, areas with low levels of health insurance were further away from stroke care compared to areas with high levels of insurance.”

The researchers said that entities that certify stroke-capable hospitals “should continue to encourage the development and certification of stroke centers in non-urban areas and emphasize the return on investment in terms of health benefits for citizens instead of economic benefits for hospitals “. At the same time, state governments can develop more integrated and coordinated care systems, including emergency medical services capable of quickly selecting and transferring stroke patients to the most appropriate stroke center.

The results of the study also reinforce the importance of knowing the stroke care centers in your community. “Not all hospitals have the resources to provide care for stroke. Patients and their families can defend their well-being by insisting on being transferred to a qualified stroke hospital,” he said.

The current study is limited based in part on state websites to identify stroke centers and the inability to consider policies that may instruct emergency medical services to avoid certain hospitals. Since traffic congestion can increase in certain areas, the study is also limited to having distance measurements, but not travel time.

An editorial accompanied by Michael T. Mullen, MD, MS, and Olajide A. Williams, MDMS, acknowledged that this study is based on previous work, but did not distinguish between primary stroke centers and comprehensive centers, which offer different levels. stroke care.

In addition, Mullen and Williams write that the distance to a stroke hospital is just one piece of a series of much broader issues: “Geographic accessibility is not the same as access to care and can not translate into improved stroke outcomes … Systematic differences in hospital performance related to actual performance may also influence stroke outcomes regardless of distance barriers. However, addressing the barriers posed by physical distance to stroke centers, as highlighted in this study, is necessary and important research. “

Kansagra and his co-researchers are analyzing the extent to which Americans must travel to receive a mechanical thrombectomy, a surgical procedure used to remove blood clots in patients suffering from severe stroke caused by clots.

To recognize the symptoms of stroke that require immediate treatment, the American Stroke Association recommends that everyone remember the acronym FAST for Falling Face, weakness of the arm, difficulty speaking, time to call 9-1-1.

According to statistics on heart disease and stroke from the American Heart Association – 2021 Update, when considered separately from other cardiovascular diseases, it ranks No. 5 among all causes of death in the United States and is the leading cause of severe disability in adults. Stroke occurs when a blood vessel to the brain or to the brain is blocked or exploded, preventing blood and oxygen from reaching the entire brain.

Mayo Minute Clinic: African Americans at Higher Risk of Stroke

More information:
Stroke (2021). DOI: 10.1161 / STROKEAHA.121.034493

Citation: Rural Residents, American Indians Travel Further to Get Certified Stroke Care (2021, June 10), Retrieved June 10, 2021 at residents-american-indians-farthest.html

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