Stroke Survival Rates Drop Precipitously in Remote Areas

Compared with patients hospitalized in urban areas, the study found that the risk of death was 21% higher for patients hospitalized in small towns.

Survival rates for stroke victims in rural areas worsens significantly the farther they live from population centers, a new study showed.

Writing in the journal Stroke, Researchers at Washington University School of Medicine in St. Louis looked at data from more than 790,000 patients nationwide who were hospitalized for stroke from 2012 through 2017.

They found that overall, in-hospital mortality was about 6%.

Compared with patients hospitalized in urban areas, however, the study found that the risk of death was about 5% higher for patients hospitalized in large towns (with populations of 250,000 to 1 million people), 10% higher for patients in small towns (with populations of 50,000 to 250,000), 16% higher for patients in rural areas (with populations of 10,000 to 50,000) and 21% higher for patients in remote rural areas (with populations of less than 10,000).

The gaps did not improve over the five-year span of the study.

"Our data suggest rural patients are missing out on access to more advanced stroke therapies and that action is needed to address these disparities and ensure that people can get the care they need, no matter where they live," said senior author Karen Joynt Maddox, MD, an assistant professor of medicine at Washington University School of Medicine.

"In this day and age, it's unacceptable that people don't have access to advanced care. But since stroke therapy is complex, solutions are not going to be one-size-fits-all," she said. "We need to think fundamentally differently about how we deliver stroke care in rural areas to begin reducing these disparities."

Stroke is the fifth-leading cause of death in the United States, with 140,000 deaths annually, according to the Centers for Disease Control and Prevention.

In more rural areas, the investigators also found that patients were less likely to receive either of two advanced stroke treatments: intravenous thrombolysis; and endovascular therapy.

"It's not realistic to expect small, rural hospitals to perform some of the more advanced procedures, such as endovascular therapy," Joynt Maddox said. "But they can recognize when patients need more advanced care and transfer patients to a hospital that has those capabilities."

"One problem is that health systems don't have consistent, widespread procedures in place to make sure that stroke patients in rural areas have access to these technologies when they need them," she said.

Making matters worse for rural patients is the time factor. Clot-busting drugs must be administered within the first three hours after the onset of symptoms, and endovascular therapy must be given within six to eight hours after symptoms appear. After these time points, the risks of the procedures, especially internal bleeding, begin to outweigh the benefits.

The study didn’t assess the time lapse between the onset of symptoms and the first treatments being administered, but they believe rural patients may live or work farther from hospitals and have to wait longer for emergency services to respond to a 911 call than patients in urban areas.