School of Medicine

Stroke survival rates worse in rural areas, study says

Pictured is an MRI of blood vessels in the brain. An interruption in blood flow to the brain causes a stroke. A new study from Washington University School of Medicine in St. Louis reveals that stroke care in rural areas lags significantly behind that available in urban centers. (Image: Getty Images)

A major U.S. study reveals large gaps between urban and rural patients in quality of care received after a stroke and rates of survival. In more rural areas, the ability of hospitals to deliver advanced stroke care is lower and mortality rates substantially higher, the research shows.

The analysis, involving nearly 800,000 patients, was led by researchers at Washington University School of Medicine in St. Louis. Their findings are published June 18 in the journal Stroke.

“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, assistant professor 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. We need to think fundamentally differently about how we deliver stroke care in rural areas to begin reducing these disparities.”

In an effort to understand the circumstances that contribute to growing differences in life expectancy between urban and rural populations, the researchers focused on stroke. It is the fifth-leading cause of death in the U.S., with 140,000 deaths annually, according to the Centers for Disease Control and Prevention. Strokes typically occur suddenly, when a blood clot interrupts the brain’s blood supply. Past studies of urban-rural differences in stroke care and mortality have been limited to single medical centers, individual states or were conducted before modern advances in stroke care became available.

The researchers studied data from more than 790,000 patients nationwide who were hospitalized for stroke from 2012 through 2017. Overall, in-hospital mortality was about 6%. However, compared with patients hospitalized in urban areas, 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). These gaps did not improve over the five-year span of the study.

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