Abstract WP59: Sex And Age Specific Differences In Rehabilitation Attendance Between Rural And Urban Stroke Patients In The United States

Abstract

Background: Stroke rehabilitation (SR) has been outlined in ASA/AHA guidelines as a critical component of post-acute care. US studies from the 2000s have found associations between rural residence and lower SR attendance, but contemporary information about SR attendance across geographic areas and patient subgroups is limited. Methods: Using the most recent 2011, 2013, 2015, and 2017 self-reported Behavioral Risk Factor Surveillance System (BRFSS) Surveys with SR data, we identified US adult stroke patients in 20 states. Rural/urban residence was classified by the Metropolitan Statistical Area codes. We compared SR attendance (Yes/No) among rural and urban stroke patients by sex and age groups (18-44y, 45-64y, 65+y). Logistic regression was used to examine the association between rural/urban residence and SR while controlling for key sociodemographic factors. Survey weighting was applied to all analyses. Results: Among 7878 stroke patients (40.8% rural, 62.2% women), slightly less rural residents attended SR compared to urban ones (30.8% vs 32.6%, p=0.357) ( Figure ). Rural/urban residence was not associated with SR prior to and after adjustment for sex, age, race, education, income, insurance status, and having a personal doctor (OR: 0.96, 95% CI: 0.80-1.15). In stratified analyses, women, patients 18-44y, and 45-64y who live in rural areas were less likely to attend SR than their urban counterparts. Women also had lower SR than men, irrespective of rural/urban residence. Conclusions: On average, a third of US stroke patients went to SR with no association found between rural/urban residence and SR attendance. However, a pattern of lower SR rates was observed across some sex and age subgroups in rural areas and in women regardless of residence status. Targeted interventions are needed to address rural/urban disparities and optimize secondary stroke prevention utilization, especially among women and young to middle aged patients in US rural areas.