Date Published: April 10, 2019
Publisher: Public Library of Science
Author(s): Andrija Javor, Julia Ferrari, Alexandra Posekany, Susanne Asenbaum-Nan, Denis Bourgeois.
Differences in stroke risk factors and treatment variables between rural and urban regions in Austria were analyzed retrospectively as European data on this topic are scarce.
We performed statistical analysis using group comparisons and time series analysis of data of the Austrian Stroke Unit Registry between 2005 and 2016. 87411 patients were divided into three groups (rural, intermediate, urban) according to the degree of urbanisation classification of the European Commission/Eurostat.
Patients in the rural group were significantly younger, more often female, had a lower pre-stroke disability, and were more frequently transported by an emergency physician. Vascular risk factors were significantly higher in urban patients, leading to a higher rate of microangiopathic etiology. Onset-to-door (ODT) and Onset-to-treatment times were significantly higher in the rural group, but ODTs decreased over time. Door-to-needle times and time to first vascular imaging were significantly lower in the rural group. Intravenous thrombolysis and rehabilitation rates were lower in urban patients.
Contrary to previous literature predominantly from outside of Europe, vascular risk factors were higher in Austrian urban patients. Further, rural patients had higher intravenous thrombolysis and rehabilitation rates maybe because of lower pre-stroke disability. ODTs in rural patients were generally higher, but they decreased over time, which might be a consequence of better education of the public in noticing early stroke signs, better transportation and education of emergency medical personnel, better advance notification to the receiving hospital and implementation of Stroke Units in rural areas.
Ischemic stroke is responsible for a significant portion of disease burden and deaths, but outcome and incidence rates vary significantly between countries, as well as urban and rural regions . Disparities between urban and rural regions in stroke care are increasing, which makes this topic increasingly important from a public health perspective .
The Austrian Stroke Unit Registry prospectively collects data on standard characteristics, management, and outcome of stroke patients admitted to one of the currently 38 Austrian Stroke units. It is financed by the Federal Ministry of Health and is centrally administered by the Gesundheit Österreich GmbH. Stroke-relevant data is documented since 2003 in an anonymized fashion and scientific analyses have to be approved and supervised by an expert committee. Data entry, data protection, administration, and scientific analysis are regulated by the Federal Law on Quality in Health, the Federal Law on Gesundheit Österreich GmbH § 15a, and the Stroke Unit Registry Act.
A detailed overview of all results is delineated in Tables 1–3. In summary, there was a significant difference in age and gender (each p<0.001), with higher age in the urban compared to the other groups [median age urban (Q0.25, Q0.75): 74.3 years (63.5, 83.2), intermediate: 73.4 (63.1, 81.5), and rural group: 73.7 (63.1, 81.3)] and a higher rate of females [urban: 14715 (51.4%), intermediate: 9999 (46.5%), rural group: 17123 (45.9%)]. In this study we analyzed data from the Austrian stroke Registry in order to contribute data from a high-income European country on differences between rural and urban populations in stroke risk factors and treatment variables, because until now literature was dominated by studies on non-European and low-income countries, and these findings cannot be easily translated to high-income countries . Source: http://doi.org/10.1371/journal.pone.0214980