Disparities in outcomes associated with rural-urban insurance status in China among inpatient women with stroke: a registry-based cohort study

Abstract

Background: Despite a few studies have demonstrated sex differences in stroke care and outcomes, limited research has explored insurance-related disparities in outcomes, particularly among women stroke patients.The aim was to determine whether rural-urban health insurance status affect the stroke treatment, process of care, and 1-year clinical outcomes for inpatient ischemic stroke in women.Methods: Women patients with acute ischemic stroke (AIS) covered by New Rural Cooperative Medical Scheme (NRCMS) and urban resident/employee-based basic medical insurance scheme (URBMI/UEBMI) were abstracted from the China National Stroke Registry II (CNSR II). Shared frailty model in the Cox model or generalized estimating equation with consideration of the hospital's cluster effect were used to assess the associations between rural-urban insurance status and quality of care during hospitalization and 1-year stroke outcomes including all-cause death, 1-year recurrence, and 1-year disability.Results: A total of 5,707 women patients enrolled from 219 hospitals in CNSR II were analyzed.Compared with 2,880 women patients covered by URBMI/UEBMI, 2,827 women patients covered by NRCMS were younger (65.7 versus 68.9 years), less likely to have vascular risk factors, awareness and treatment of hypertension and dyslipidemia prior to stroke. Women covered by NRCMS were more likely to receive early antithrombotics, discharge antithrombotics, lipid-lowering drugs, but less likely to receive antihypertensive medication than those covered by URBMI/UEBMI. One-year all-cause mortality and stroke recurrence were both significantly higher in women patients with NRCMS than those with URBMI/ UEBMI [adjusted hazard ratio (95% confidence interval): 1.40 (1.06-1.84) and 1.38 (1.04-1.83), separately].Conclusions: AIS women patients with rural-urban insurance status demonstrated remarkable differences in age, stroke risk factors, awareness and treatment, the process of care, and 1-year stroke recurrence and mortality. Healthcare policymakers need to focus their attention on these disparities and take proper steps to improve primary healthcare service in rural areas. Gu et al. Disparities in outcomes among inpatient women with stroke in China

Ischemic Stroke in Women Admitted in a Tertiary Hospital in Burkina Faso

“…This observation was consistent with several studies witch report longer times from symptom onset to emergency department (ED) arrival for women [26][27][28]. About seventy percent of women had severe stroke at admission (NIHSS>15), higher than in the study of GU (6.9%) [21] and Ong (20.9%) [29]. Women had higher NIHSS at admission (14.77) than in Spain (9.4 ± 6.94) [18] and China (5.4 ± 5.6) [21].…”

“…Similar descriptions were observed by Caso V, et al [18] in Spain (75%), Forster (83.8%) [20], and Musa in Nigeria (83.3%) [15]. The prevalence of Diabetes mellitus was lower than in the study of Gu in China: 15.9% versus 24.3% [21]. According to age group, hypertension and diabetes mellitus had significant role in the developing of ischemic stroke in older women, in concordance with several studies [22][23][24].…”

Inconsistent centralised versus non-centralised ischaemic stroke aetiology

“…3 4 Although gradual improvements in stroke care have been achieved in recent years, regional differences still exist in the quality of diagnostic measures and stroke recurrence. [5][6][7] Accurate classification of ischaemic stroke aetiology is indispensable for patient management and research because stroke prognosis 8 and strategies for secondary prevention of stroke differ by stroke subtype. [9][10][11] There are several aetiological subtyping systems [12][13][14][15][16][17][18][19] ; however, despite the limited discriminatory ability and prognostic value, 8 the Trial of Org 10 172 in Acute Stroke Treatment (TOAST) system 12 remains the most widely used aetiological categorising system in clinical research and practice.…”

“… 3 4 Although gradual improvements in stroke care have been achieved in recent years, regional differences still exist in the quality of diagnostic measures and stroke recurrence. 5–7 …”

Astrocytic histone deacetylase 2 facilitates delayed depression and memory impairment after subarachnoid hemorrhage by negatively regulating glutamate transporter-1

“…Spontaneous subarachnoid hemorrhage (SAH), one of the most common hemorrhagic cerebrovascular diseases, is principally caused by ruptured intracranial aneurysms (1). Severe cognitive impairment, including depression, anxiety, and memory impairment, affects more than 20% of patients who survive (2).…”