Stroke risk factors and treatment variables in rural and urban Austria: An analysis of the Austrian Stroke Unit Registry.

Andrija Javor,Julia Ferrari,Susanne Asenbaum-Nan,Alexandra Posekany,Denis Bourgeois

doi:10.1371/journal.pone.0214980

Abstract

Background and objectivesDifferences 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.Research design and methodsWe 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.ResultsPatients 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.Discussion and implicationsContrary 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.

Highlights

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 [1]
Onset-to-door (ODT) and Onset-to-treatment times were significantly higher in the rural group, but onset-to-door time (ODT) decreased over time
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

Summary

Introduction

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 [1]. Data from other world regions hint to suboptimal care in rural regions [8] This might be explained by the level of education in recognition of stroke symptoms by the population, paramedics training, and transit times to hospitals [9] or the fact that patients in rural regions were less likely treated in Stroke units and to receive quick brain and vascular imaging, as well as consultations from neurologists and therapists and rehabilitation [10,11]. There seem to be differences in stroke risk factors between rural and urban populations [12]. 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

Methods

Results

Conclusion