Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Kapral, Moira K.; Hall, Ruth; Gozdyra, Peter; Yu, Amy Y.X.; Jin, Albert; Martin, Cally; Silver, Frank L.; Swartz, Richard H.; Dujovny, Manuel; Fang, Jiming; Porter, Joan; Koifman, Julius; Austin, Peter C.

doi:10.1017/cjn.2020.9

Cited by 19 publications

(18 citation statements)

References 42 publications

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“…The ability to clearly locate specific population groups provides the opportunity to identify risk areas in preventive research. The effects of different population distributions reinforce previous findings on inequality in medical care [ 28 , 53 ]. Thus, we show that a multitemporal view of the population distribution can produce variations in the accessibility situation in the same way as the use of different speed scenarios.…”

Section: Discussionsupporting

confidence: 86%

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

et al. 2021

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Purpose Rapid accessibility of (intensive) medical care can make the difference between life and death. Initial care in case of strokes is highly dependent on the location of the patient and the traffic situation for supply vehicles. In this methodologically oriented paper we want to determine the inequivalence of the risks in this respect. Methods Using GIS we calculate the driving time between Stroke Units in the district of Münster, Germany for the population distribution at day- & nighttime. Eight different speed scenarios are considered. In order to gain the highest possible spatial resolution, we disaggregate reported population counts from administrative units with respect to a variety of factors onto building level. Results The overall accessibility of urban areas is better than in less urban districts using the base scenario. In that scenario 6.5% of the population at daytime and 6.8% at nighttime cannot be reached within a 30-min limit for the first care. Assuming a worse traffic situation, which is realistic at daytime, 18.1% of the population fail the proposed limit. Conclusions In general, we reveal inequivalence of the risks in case of a stroke depending on locations and times of the day. The ability to drive at high average speeds is a crucial factor in emergency care. Further important factors are the different population distribution at day and night and the locations of health care facilities. With the increasing centralization of hospital locations, rural residents in particular will face a worse accessibility situation.

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Section: Discussionsupporting

confidence: 86%

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

et al. 2021

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“…Social demographics such as socioeconomic status, sex, geographic location, income, and education are still important factors affecting the accessibility of health services, especially in rural areas [46]. Previous studies in Canada have suggested that rural residents have reduced access to basic stroke care, such as computed tomography, thrombolysis, a stroke unit, a stroke prevention clinic, or inpatient rehabilitation once they have had a stroke, and therefore experience relatively more severe outcomes, including disability [47,48]. Our study also found that dialysis patients living in severely affected areas had a higher risk of mortality than patients in moderately affected areas.…”

Section: Discussionmentioning

confidence: 99%

Maintaining Quality of Care among Dialysis Patients in Affected Areas after Typhoon Morakot

Chang

Chao

Huang

et al. 2021

IJERPH

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Natural disasters have negative health impacts on patients who need dialysis in affected areas. Severely affected areas are usually rural, with limited basic infrastructure and a population without optimal dialysis-specific care after a disaster. A population-based longitudinal case–cohort study enrolled 715,244 adults from the National Health Insurance Registry who lived in areas affected by a major natural disaster, Typhoon Morakot, in 2009. The observation period was from 2008 to 2011. A total of 13,268 patients (1.85%) had a history of end-stage renal disease (ESRD). Of the ESRD patients, 1264 patients (9.5%) received regular dialysis. Only eight patients missed dialysis sessions in the first month after the disaster. Compared to the moderately affected areas, the incidences of acute cerebrovascular and cardiovascular diseases were higher in patients in severely affected areas. Male dialysis patients aged 45–75 years had a higher mortality rate than that of the general population. Among the affected adults receiving regular dialysis, patients with diabetes (adjusted hazard ratio (aHR): 1.58, 95% confidence interval (CI): 1.20–2.08) or a history of cerebrovascular disease (aHR: 1.58, 95% CI: 1.12–2.21), chronic obstructive pulmonary disease (COPD) or asthma (aHR: 1.99, 95% CI: 1.24–3.17) in moderately affected areas had significantly elevated mortality rates. Additionally, among dialysis patients living in severely affected areas, those with a history of cerebrovascular disease (aHR: 4.52 95% CI: 2.28–8.79) had an elevated mortality rate. Early evacuation plans and high-quality, accessible care for cardiovascular and cerebrovascular diseases are essential to support affected populations before and after disasters to improve dialysis patients’ health outcomes.

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“…It is unknown how much this would influence our data given that MRI is more costly and time-consuming in the acute setting compared to CT imaging and is not widely available across the province. 44 The effect of the tissue-based definition on TIA diagnoses will therefore depend on both the timing of clinical evaluation and access to DWI. 45 There was a significant amount of missing data on MRI utilization in our study, which hindered our ability to examine the potential impact of MRI on TIA diagnoses.…”

Section: Discussionmentioning

confidence: 99%

Reduction in Stroke After Transient Ischemic Attack in a Province-Wide Cohort Between 2003 and 2015

Wang

Kapoor

Lindsay

et al. 2020

Can. J. Neurol. Sci.

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Background: Improvements in management of transient ischemic attack (TIA) have decreased stroke and mortality post-TIA. Studies examining trends over time on a provincial level are limited. We analyzed whether efforts to improve management have decreased the rate of stroke and mortality after TIA from 2003 to 2015 across an entire province. Methods: Using administrative data from the Canadian Institute for Health Information’s (CIHI) databases from 2003 to 2015, we identified a cohort of patients with a diagnosis of TIA upon discharge from the emergency department (ED). We examined stroke rates at Day 1, 2, 7, 30, 90, 180, and 365 post-TIA and 1-year mortality rates and compared trends over time between 2003 and 2015. Results: From 2003 to 2015 in Ontario, there were 61,710 patients with an ED diagnosis of TIA. Linear regressions of stroke after the index TIA showed a significant decline between 2003 and 2015, decreasing by 25% at Day 180 and 32% at 1 year (p < 0.01). The 1-year stroke rate decreased from 6.0% in 2003 to 3.4% in 2015. Early (within 48 h) stroke after TIA continued to represent approximately half of the 1-year event rates. The 1-year mortality rate after ED discharge following a TIA decreased from 1.3% in 2003 to 0.3% in 2015 (p < 0.001). Interpretation: At a province-wide level, 1-year rates of stroke and mortality after TIA have declined significantly between 2003 and 2015, suggesting that efforts to improve management may have contributed toward the decline in long-term risk of stroke and mortality. Continued efforts are needed to further reduce the immediate risk of stroke following a TIA.

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Geographic Access to Stroke Care Services in Rural Communities in Ontario, Canada

Cited by 19 publications

References 42 publications

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

Risk and space: modelling the accessibility of stroke centers using day- & nighttime population distribution and different transportation scenarios

Maintaining Quality of Care among Dialysis Patients in Affected Areas after Typhoon Morakot

Reduction in Stroke After Transient Ischemic Attack in a Province-Wide Cohort Between 2003 and 2015

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