Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study

Ruiz-Sandoval, José Luís; Briseño-Godínez, María Eugenia; Chiquete-Anaya, Erwin; Arauz-Góngora, Antonio; Troyo-Sanromán, Rogelio; Parada-Garza, Juan Didier; Ramos-Moreno, Alma; Barinagarrementería, Fernando; Murillo-Bonilla, Luis Manuel; Cantú-Brito, Carlos; Investigators, Premier

doi:10.1016/j.jstrokecerebrovasdis.2017.09.025

Cited by 12 publications

(11 citation statements)

References 20 publications

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“…That could be because, in Australia, patients may be seen by a neurologist to treat stroke patients, and studies show that patients who are seen by a neurologist have a better outcome. 36,47,48 In the same way, the one-year survival rate of the current finding, 81.39%, is found to be lower compared with 91.8% of the one-year survival rate in China. 49 The difference could be due to inclusion criteria (our study focused on both types of stroke, whereas the previous study only on ischemic stroke), management team and supplies, patient load, patient clinical profile, and a difference in following management protocol.…”

Section: Discussionsupporting

confidence: 66%

“…Our study also excludes stroke patients who received treatment at private health institutions, as well as patients who received treatment at an emergency department and either went home for a full recovery or died there. A study from Mexico concluded that private hospital deaths account for up to 10% of stroke deaths, 47 due to this reason accurate survival rate of stroke patients in our study may be biased.…”

Section: Limitations Of the Studymentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

Walelgn¹,

Abyu²,

Seyoum³

et al. 2021

RMHP

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Introduction: Stroke is one of the commonest non-communicable disease types that has a great public health impact both in developed and developing countries. However, in Ethiopia, the long-term survival status of stroke patients is not very understood. This study aimed at assessing survival status and predictors of mortality among stroke patients at Felege Hiwot comprehensive specialized hospital from September 1, 2014, to August 31, 2019, Bahirdar, North West Ethiopia. Methods: An institutional-based retrospective cohort study was conducted using 368 registered stroke patients between September 1, 2014, and August 31, 2019. We used Kaplan-Meier together with a Log-rank test to compare the survival rate of the study participants using categorical variables and to compare covariate and both bi-variable and multivariable Cox proportional hazards regression analysis model was conducted to identify predictors of mortality among stroke patients. The association between outcome and independent variables was expressed using an adjusted hazard ratio (AHR) with a 95% confidence interval and statistical significances were declared at P-value of <0.05. Results: Fifty-six (15.2%) of the 368 stroke patients included in the study died, and 312 (84.8%) were correctly censored. The overall survival rate was 72.2% at 51 months of follow-up with a median survival time of 0.26 months. Age greater than 65 (AHR 6.31, 95% CI 1.75-22.74), body temperature >7.1 degree centigrade (AHR = 7.14, 95% CI: 2.76-18.5), potassium level below <2 mmol/l (AHR = 2, 95% CI: 1.9-23.53) and creatinine level >1.2 mg/dl (AHR = 7.85, 95% CI: 2.7-22.6) were predictive predictors of mortality. Conclusions: In the follow-up of 51 months, significant mortality occurred. Important predictive predictors of survival status were identified. Interventions should be focused on health education and awareness creation of the community for the early management of stroke.

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Section: Discussionsupporting

confidence: 66%

Section: Limitations Of the Studymentioning

confidence: 83%

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The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

Walelgn¹,

Abyu²,

Seyoum³

et al. 2021

RMHP

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“…The lack of acute stroke care systematization and implementation of the current evidence-based acute therapeutic strategies unveils the limitations of a fragmented healthcare system (in Mexico, there are seven central autonomous public healthcare institutions) not completely covering the entire population. Moreover, there are notable differences in the celerity and quality of care in public vs. private hospitals and emergency care providers in Mexico [ 14 , 15 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Stroke Care in Mexico City: The Hospital Phase of a Stroke Surveillance Study

et al. 2022

Self Cite

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Background: Acute stroke care has greatly improved in recent decades. However, the increasing stroke mortality in low-to-middle income countries suggests that progress has not been reached completely by these populations. Here we present the analysis of the hospital phase of the first population-based stroke surveillance study. Methods: A daily hospital surveillance method was used to identify adult patients with acute stroke during 18 months in six hospitals. We abstracted data on demographics, vascular risk factors, neuroimaging-confirmed stroke types, and clinical data. Results: A total of 1361 adults with acute stroke were identified (mean age 69.2 years; 52% women) with transient ischemic attack (5.5%), acute ischemic stroke (68.6%), intracerebral hemorrhage (23.1%), cerebral venous thrombosis (0.2%), and undetermined stroke (2.6%). The main risk factors were hypertension (80.7%) and diabetes mellitus (47.6%). The usage rate of thrombolysis was 3.6%, in spite of the fact that 37.2% of acute ischemic stroke patients arrived in <4.5 h. The 30-day case fatality rate was 32.6%, higher in hemorrhagic than ischemic stroke. Conclusion: We identified limitations in acute stroke care in the Mexico City, including neuroimaging availability and thrombolysis usage. The door-to-door phase will help to depict the acute stroke burden in Mexico.

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“…For IBD, an increase in hospital discharges and mortality has been reported in the last years [ 15 ], for that reason a greater coverage of medical treatments is necessary for IBD. There are differences in the clinical outcomes depending on the health care system with higher mortality and complications in the public health system [ 16 , 17 ] than the private health care system. In other countries, that have both health systems, it has been observed that patients with IBD with medical attention in the public health system have a higher percentage of diagnostic delay and late use of anti-TNF therapy resulting in an elevated number of hospitalizations [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients

Yamamoto‐Furusho

Parra-Holguín

2021

Inflamm Intest Dis

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Introduction: Inflammatory bowel disease (IBD) includes ulcerative colitis (UC) and Crohn’s disease (CD) characterized by a fluctuating course with periods of clinical activity and remission. No previous studies have demonstrated the frequency of delay at diagnosis and its associated factors in Mexico and Latin America. The aim of this study was to evaluate diagnostic delay of IBD in the last 4 decades in 2 different health care systems (public vs. private) and its associated factors. Methods: This is a cohort study that included 1,056 patients with a confirmed diagnosis of IBD from public and private health care systems. The diagnostic delay was defined as time >1 year from the onset of symptoms to the confirmed diagnosis for patients with UC and 2 years for patients with CD. Statistical analysis was performed with the SPSS v.24 program. A value of p ≤ 0.05 was taken as significant. Results: The delay at diagnosis decreased significantly by 24.9% in the last 4 decades. The factors associated with the diagnostic delay were proctitis in UC, clinical course >2 relapses per year and IBD surgeries for CD. We found a delay at diagnosis in 35.2% of IBD patients in the public versus 16.9% in the private health care system (p = 0.00001). Conclusions: We found a significant diagnosis delay of IBD in 35.2% from the public health care system versus 16.9% in the private health care system.

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Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study

Cited by 12 publications

References 20 publications

The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

The Survival Status and Predictors of Mortality Among Stroke Patients at North West Ethiopia

Acute Stroke Care in Mexico City: The Hospital Phase of a Stroke Surveillance Study

Diagnostic Delay of Inflammatory Bowel Disease Is Significantly Higher in Public versus Private Health Care System in Mexican Patients

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