학술논문
Regional Disparities in Hyperacute Treatment and Functional Outcomes after Acute Ischemic Stroke in Japan.
Document Type
Academic Journal
Author
Fujiwara G; Department of Technology and Intellectual Property, Graduate School of Medicine and Public Health, Kyoto University.; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University.; Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc.; Kondo N; Department of Social Epidemiology, Graduate School of Medicine and Public Health, Kyoto University.; Oka H; Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc.; Fujii A; Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc.; Kawakami K; Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University.
Source
Publisher: Japan Atherosclerosis Society Country of Publication: Japan NLM ID: 9506298 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1880-3873 (Electronic) Linking ISSN: 13403478 NLM ISO Abbreviation: J Atheroscler Thromb Subsets: MEDLINE
Subject
Language
English
Abstract
Aim: This study investigated the impact of rurality on acute ischemic stroke (AIS) outcomes, emphasizing the hyperacute phase, in which immediate care is crucial.
Methods: This retrospective cohort study analyzed data from a large Japanese hospital network covering AIS patients from 2013-2021, was analyzed. The focus was on patients admitted within 4.5 h of the onset, using the Rurality Index for Japan (RIJ) to categorize patients into rural or urban groups. This study examined treatment methods (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) and functional outcomes measured using the modified Rankin Scale (mRS), where scores of 3-6 indicated poor outcomes. Multilevel logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for poor outcomes baSed on rurality. The study also evaluated the population-attributable fraction (PAF) to estimate potential outcome improvements in urban settings.
Results: Of 27,691 patients, 17,516 were included in the total cohort and 4,954 in the hyperacute cohort. Urban patients constituted 73.7% (12,902), with higher IVT (5.2%) and MT (3.6%) rates than rural patients (4.1% IVT, 2.0% MT). Poor mRS outcomes were more common in rural areas than in urban areas, with adjusted ORs of 1.30 (1.18-1.43) in the total cohort and 1.43 (1.19-1.70) in the hyperacute cohort. The PAF for poor outcomes due to rural residency was 14.8% (0.5%-31.0%).
Conclusion: This study demonstrated a notable association between rurality and poorer AIS outcomes in Japan, particularly in the hyperacute phase.
Methods: This retrospective cohort study analyzed data from a large Japanese hospital network covering AIS patients from 2013-2021, was analyzed. The focus was on patients admitted within 4.5 h of the onset, using the Rurality Index for Japan (RIJ) to categorize patients into rural or urban groups. This study examined treatment methods (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]) and functional outcomes measured using the modified Rankin Scale (mRS), where scores of 3-6 indicated poor outcomes. Multilevel logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for poor outcomes baSed on rurality. The study also evaluated the population-attributable fraction (PAF) to estimate potential outcome improvements in urban settings.
Results: Of 27,691 patients, 17,516 were included in the total cohort and 4,954 in the hyperacute cohort. Urban patients constituted 73.7% (12,902), with higher IVT (5.2%) and MT (3.6%) rates than rural patients (4.1% IVT, 2.0% MT). Poor mRS outcomes were more common in rural areas than in urban areas, with adjusted ORs of 1.30 (1.18-1.43) in the total cohort and 1.43 (1.19-1.70) in the hyperacute cohort. The PAF for poor outcomes due to rural residency was 14.8% (0.5%-31.0%).
Conclusion: This study demonstrated a notable association between rurality and poorer AIS outcomes in Japan, particularly in the hyperacute phase.