Skip to main content
padlock icon - secure page this page is secure

Metropolitan–rural divide for stroke outcomes: do stroke units make a difference?

Buy Article:

$52.00 + tax (Refund Policy)

Abstract Background: 

Stroke care across Australian hospitals is variable. The impact on health outcomes, in particular levels of disability for patients in rural areas, is unclear. The aim of this study was to determine whether geographic location and access to stroke units are associated with differences in health outcomes in patients with acute stroke. Methods: 

Retrospective cohort study of consecutive eligible admissions from 32 hospitals (12 rural) in New South Wales between 2003 and 2007. Health status measured at discharge included level of independence (modified Rankin score: mRS) and frequency of severe complications during hospitalization. Multivariable analyses included adjustment for patient casemix and clustering. Results: 

Among 2254 eligible patients, 55% were treated in metropolitan hospitals. Stroke unit treatment varied significantly (rural 3%; metropolitan 77%). Age, gender and stroke type did not differ by location (mean age 74, 50% female). After adjusting for age, gender, ethnicity, important risk factors and validated stroke prognostic variables, patients treated in rural hospitals had a greater odds of dying during hospitalization compared with those treated in metropolitan hospitals (adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI) 1.03–2.05). There were no differences in mortality or frequency of severe complications between patients treated in rural and metropolitan hospitals when we adjusted for access to stroke units (aOR 1.00, 95% CI 0.62–1.61). Nevertheless, patients treated in rural hospitals were more dependent (mRS 3–5) at discharge (aOR 1.82, 95% CI 1.23–2.70) despite adjusting for stroke unit status. Conclusion: 

Patients with stroke treated in rural hospitals have poorer health outcomes, especially if not managed in stroke units.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Keywords: New South Wales; metropolitan hospital; outcome assessment (healthcare); rural hospital; stroke

Document Type: Research Article

Affiliations: 1: Stroke Services New South Wales Greater Metropolitan Clinical Taskforce, NSW Health, Sydney 2: Hunter Stroke Service, Hunter New England Area Health

Publication date: April 1, 2011

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more