Clinical characteristics, in-hospital management, and outcomes among patients hospitalized for acute ischemic stroke in rural vs. urban hospitals in China: a nationwide hospital-based study

IF 6.3 2区医学 Q1 CLINICAL NEUROLOGY

International Journal of Stroke Pub Date : 2024-09-14 DOI:10.1177/17474930241286709

Zhikai Zhu, Yingyu Jiang, Xin Yang, Chunjuan Wang, Yingxi Chen, Zixiao Li, Yongjun Wang, Yong Jiang, Hong-Qiu Gu

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Abstract

BackgroundEfforts to improve rural stroke care have intensified in China. However, high-quality comprehensive data on the differences in care and outcomes between urban and rural hospitals are limited.MethodsWe analyzed data on patients with acute ischemic stroke hospitalized in the China Stroke Center Alliance hospitals from 2015 to 2022. The in-hospital management measures assessed included nine acute and five discharge management measures. Outcomes evaluated included death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACE), disability at discharge, and in-hospital complications.ResultsWe enrolled 1,583,271 patients with acute ischemic stroke from 1,930 hospitals, comprising 1 086 (56.3%) rural sites with 735 452 patients and 844 (43.7%) urban sites with 847 891 patients. Patients in rural hospitals demonstrate suboptimal management measures compared to those in urban hospitals, including lower rates of intravenous recombinant tissue plasminogen activator within 4.5 h (26.0% vs. 28.3%; difference, -2.3% [-2.5% to -2.0%]), endovascular treatment (0.6% vs. 1.9%; difference, -1.3% [-1.3% to -1.2%]), vessel assessment (88.5% vs. 92.0%; difference, -3.5% [95% CI, -3.6% to -3.4%]), and anticoagulants for atrial fibrillation at discharge (42.9% vs. 47.7%; difference, -4.8% [95% CI, -5.4% to -4.2%]). Overall, the rural-urban disparity in in-hospital outcomes was small. Rural patients had a slightly higher rate of in-hospital death/DAMA (9.0% vs. 8.0%; aOR, 1.22 [95% CI, 1.20–1.23]; aRD, 1.3% [95% CI, 1.2%–1.4%]) and a slightly lower rate of complications (10.9% vs. 13.0%; aOR, 0.83 [95% CI, 0.82–0.84]; aRD, -1.3% [95% CI, -1.3%–1.3%]). No notable rural-urban differences were observed in MACE and disability at discharge.ConclusionsPatients in rural hospitals demonstrated suboptimal management measures and had higher rates of in-hospital death/DAMA compared to those in urban hospitals. Prioritizing the allocation of health resources to rural hospitals is essential to improve healthcare quality and outcomes.Data access statementThe data supporting the findings of this study are available from the corresponding author upon reasonable request.

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中国农村医院与城市医院急性缺血性脑卒中住院患者的临床特征、院内管理和预后：一项基于医院的全国性研究

背景中国加大了改善农村卒中救治的力度。方法我们分析了 2015 年至 2022 年在中国卒中中心联盟医院住院的急性缺血性卒中患者的数据。评估的院内管理措施包括 9 项急性期管理措施和 5 项出院管理措施。评估结果包括死亡或不遵医嘱出院（DAMA）、主要不良心血管事件（MACE）、出院时残疾和院内并发症。结果我们从1930家医院招募了1,583,271名急性缺血性卒中患者，其中农村医院1,086家（56.3%），患者735,452人；城市医院844家（43.7%），患者847,891人。与城市医院相比，农村医院患者的管理措施不够理想，包括在 4.5 小时内静脉注射重组组织纤溶酶原激活剂的比例较低（26.0% 对 28.3%；差异为-2.3% [-2.5% to -2.0%]）、血管内治疗（0.6% vs. 1.9%；差异，-1.3% [-1.3% to -1.2%]）、血管评估（88.5% vs. 92.0%；差异，-3.5% [95% CI, -3.6% to -3.4%]）以及出院时房颤的抗凝治疗（42.9% vs. 47.7%；差异，-4.8% [95% CI, -5.4% to -4.2%]）。总体而言，农村与城市在住院结果方面的差距很小。农村患者的院内死亡/DAMA 率略高（9.0% 对 8.0%；aOR，1.22 [95% CI，1.20-1.23]；aRD，1.3% [95% CI，1.2%-1.4%]），并发症发生率略低（10.9% 对 13.0%；aOR，0.83 [95% CI，0.82-0.84]；aRD，-1.3% [95% CI，-1.3%-1.3%]）。结论与城市医院相比，农村医院患者的管理措施欠佳，院内死亡/DAMA率较高。优先向农村医院分配医疗资源对于改善医疗质量和结果至关重要。数据获取声明本研究结果的相关数据可向通讯作者索取。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Stroke 医学-外周血管病

CiteScore

13.90

自引率

6.00%

发文量

132

审稿时长

6-12 weeks

期刊介绍： The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.