Access to stroke care in England, Wales and Northern Ireland: the effect of age, gender and weekend admission

Abstract

Study objectives: to determine whether access to high-quality stroke care is affected by the age or gender of the patient or by weekend admission. Design: data were collected as part of the National Sentinel Audit of stroke in 2004, both on the organisation of in-patient stroke care and the process of care to hospitals managing stroke patients. Setting: two hundred and forty-six hospitals from England, Wales and Northern Ireland took part in the 2004 National Stroke Audit, a response rate of 100%. These sites audited the care of 8,718 patients. Audit Tool: Royal College of Physicians Intercollegiate Working Party Stroke Audit Tool. Results: overall standards of care for cases of stroke in England, Wales and Northern Ireland are low. Older patients are less likely to be treated in a stroke unit than younger patients (risk ratio comparing 85+ years with those <65 years 0.82 (95% CI 0.75-0.90). Seventy-one per cent of patients under 65 years were scanned within 24 h compared to 51% aged over 85 years. Older patients were also less likely than younger ones to receive secondary prevention and some aspects of rehabilitation, especially around higher functioning. Standards were consistently better for patients of all ages managed in stroke units compared to general wards. At weekends, patients were less likely to be admitted directly to a stroke unit (risk ratio 0.77 95% CI 0.69-0.86) and brain imaging was performed less often for older (85+ years) patients (weekday 56%, weekend 40%). There was little evidence of differences in standards of care between males and females. Conclusion: there is clear evidence of an age effect on the delivery of stroke care in England, Wales, and Northern Ireland, with older patients being less likely to receive care in line with current clinical guidelines. Quality of acute care is also less good for patients admitted at weekends. No systematic evidence for sexism was identified.

Predictors of access to pituitary tumor resection in the United States, 1988–2005

“…Younger patients are much more likely than older patients to be admitted to high-volume centers (Table 3). This is in accord with previous studies in cerebrovascular accident patients, which demonstrate that older patients are less likely to receive adequate care after a cerebrovascular accident (57,58). Another study found that older patients were less likely to receive critical care treatment (58), and Dunlop et al reported that elderly patients were less likely to be transported to trauma centers than younger patients (59).…”

“…It is interesting to note that although some reports, such as those by Rudd et al, note no association between female gender and access to care for cerebrovascular accident (57), other studies, such as those by Miles et al, report that particular subsets of women may be more likely to be uninsured and have less access to the needed healthcare (60). We are the first to report, however, that among a national group of randomly selected patients undergoing surgical resection for pituitary-related disease, female gender is a positive predictor of admission to high-volume centers.…”

Clinical and Demographic Properties of the Acute Stroke Patients Admitted to Emergency Department of a Tertiary Referral Center

“…In a comprehensive study conducted in 2009 by screening approximately 40,000 stroke patients, there was no significant difference between male and female patients in terms of rates of hemorrhagic and ischemic stroke (15). Other studies examining patients hospitalized in stroke units determined no significant difference in terms of stroke severity and type (16,17). It has been reported that female patients have a stroke at older ages compared to men, and their long-term prognosis is worse due to this reason or other accompanying factors (18,19).…”

Postdischarge quality of care: Do age disparities exist among Department of Veterans Affairs ischemic stroke patients?

“…On the other hand, individuals in the older age groups (60-69, 70-79, and 80 yr) were significantly more likely than their younger counterparts to be discharged with antihypertensive treatment. A separate study found that older individuals (85+ yr) were less likely to receive secondary prevention (e.g., documented measure of blood cholesterol) [11]. Using a nationally representative telephone self-report survey to explore disparities in 11 stroke secondary prevention services (e.g., serum glycosylated hemoglobin [HbA1c] measurement; serum cholesterol measurement), Ross and colleagues reported that individuals younger than 65 were less likely than those 65-79 to report receipt of recommended services (e.g., serum cholesterol measurement) [12].…”