A combined analysis of US census data and roadmap shows that the distance a stroke patient must travel to receive care at an accredited stroke center depends on race, age, income, and insurance status, and rural areas. The largest disparity is seen between residents and Native Americans.Published today stroke..
treatment of Ischemic stroke, The blockage of the arteries that supply blood to the brain restores blood flow to the brain. Prompt treatment is essential to reduce disability. Blood flow may be restored by administration of an intravenous thrombolytic drug within 4.5 hours of the onset of stroke symptoms, ideally within 1 hour of arrival at the hospital. All accredited stroke centers offer treatment with thrombolytic drugs and have trained medical professionals in stroke care to employ other means to improve stroke care.
“Every day we treat stroke, we face the reality that our desire to help everyone competes with the fact that millions of Americans cannot contact us on time. “We do,” said Akash Kansagra, MD, MS, senior research author and associate professor of radiology. Neurosurgery and neurology at Washington University School of Medicine in St. Louis. “Stroke patients are much more likely to recover if they can go to a stroke hospital immediately. The problem we wanted to address is that certain Americans are saved when they have a stroke. Whether I had to travel farther than other Americans to gain potential expertise. “
The 2019 American Heart Association / American Stroke Association guidelines take stroke patients to their nearest stroke response hospital through emergency medical services, and use interactive video conferencing to “ remote stroke patients” to remote patients. We recommend that you provide acute stroke care, also known as. Setting.
The American Heart Association and a joint committee are working together to provide hospitals with acute stroke preparation certification, primary stroke certification, thrombectomyable stroke certification, and comprehensive stroke certification to eligible hospitals.
Using public map services, researchers used the road distance to the closest accredited stroke center in the adjacent 48 states and the Census Zone of the District of Columbia (a small geographic area defined for the US Census). Was compared. For each census, we collected data from the US Census Bureau’s 2014-2018 American Community Survey on age, race, ethnicity, health insurance status, income, and population density. The analysis covers 98% of the entire US census area, including a population of over 316 million and more than 2,300 stroke-certified hospitals.
Researchers have pointed out that people living in the following areas have the longest distances to stroke accreditation centers: Rural, Rural areas with many elderly people, areas with few health insurance, low household income levels, and census zones with many representatives of Native Americans.
- In rural areas, the elderly-rich census district is far from the stroke center, and for every 1% increase in the population aged 65 and over, the distance traveled increases by 0.31 miles. There was no clear relationship between the density of the elderly population in urban areas and the distance to stroke care.
- Census districts, which have a high proportion of Native American residents in both urban and rural areas, are far from accredited stroke care centers and are located in urban areas for every 1% increase in Native American proportions. Travel distance is 0.06 miles longer, and in rural areas 0.66 miles longer.
- In both urban and rural areas, areas with high numbers of uninsured people were far from stroke centers. For every 1% increase in the proportion of uninsured patients, travel distance increases by 0.01 miles in urban areas and 0.17 miles in rural areas.
- The relationship between income and distance to an accredited stroke center has reversed in urban and rural areas. In urban areas, for every $ 10,000 in median household income, the distance traveled increases by 0.10 miles. In rural areas, for every $ 10,000 in household income, travel distances are reduced by 3.13 miles.
“Beyond the actual difference in geographical proximity to stroke care between urban and non-urban areas, our analysis shows demographic characteristics and stroke care in urban and rural settings. We found a significant difference in the association with proximity, “said Kansagra.
“But the trend is volatile. Strokes can occur at any age,” Kansagra said, saying it’s unclear why people over the age of 65 in rural areas are away from accredited stroke centers. However, older people are at higher risk. Those who are most likely to experience a stroke are also more likely to live away from the stroke hospital. “
Researchers say that the higher the income level, the longer the distance to stroke treatment in urban areas and the shorter the distance traveled in rural areas, probably reflecting the concentration of wealth in the suburbs. That is. “What surprised me was that in areas with many non-health insurance residents, such a reversal did not occur,” said Kansagra. “No matter where you look, the level of health insurance is Lower areas were farther away from stroke care than areas with higher levels of insurance. “
Researchers said that institutions accrediting stroke-responsive hospitals continued to encourage the development and accreditation of non-urban stroke centers and return on investment in terms of public health benefits rather than economic benefits to hospitals. At the same time, the state government has developed a more integrated and coordinated care system that includes rapid triage of stroke patients and emergency medical services that can be transferred to the most appropriate stroke center. Can be developed.
The findings also emphasize the importance of knowing about stroke care centers in the community. “Not all hospitals have the resources to provide stroke care. Patients and their families can claim their health by claiming to be taken to the appropriate stroke hospital. “I will.” He said.
Current research is limited by the partial reliance on state websites to identify stroke centers and the inability to consider policies that may direct emergency medical services to bypass certain hospitals. I have.Because there is a possibility of increased traffic Travel time In certain areas, research is limited by using distance measurements rather than travel time.
Ancillary editorials by Michael T. Mullen, MD, MS and Olajide A. Williams, MDMS acknowledged that this study was based on previous studies, but included a primary stroke center and a different level of stroke care. Did not distinguish it from a typical center.
In addition, Maren and Williams write that distance to a stroke hospital is only part of a much larger set of problems. “Geographical accessibility is not the same as access to realized care and may not lead to improved stroke outcomes …. Systematic differences in hospital characteristics related to actual performance. Can also affect stroke outcomes apart from distance barriers, but address the barriers posed by physical distance to the stroke center, as highlighted in this study. What you do is a necessary and important pursuit. “
Kansagra and his collaborators are currently analyzing how far Americans need to travel to undergo a mechanical thrombectomy.
To recognize the symptoms of stroke that need immediate treatment, the American Stroke Association has given everyone the acronym FAST for face drooping, weak arms, difficulty speaking, and time to call 9-1-1. I advise you to remember.
American Heart Association Heart Disease and Stroke Statistics — According to the 2021 update, when considered separately from other cardiovascular diseases, stroke It is the fifth leading cause of death in the United States and a major cause of serious adult disability. A stroke occurs when blood vessels to or in the brain become blocked or ruptured, preventing blood and oxygen from reaching the entire brain.
stroke (2021). DOI: 10.1161 / STROKE AHA.121.034493
American Heart Association
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Native American Indians Travel Farthest For Certified Stroke Care
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