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Björklund S, Lilja Hagell P, Hagell P, Persson M, Holmberg M. Ambulance staff's ways of understanding health care encounters in stigmatized neighborhoods - A phenomenographic study. Int Emerg Nurs 2024; 74:101451. [PMID: 38663203 DOI: 10.1016/j.ienj.2024.101451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Sara Björklund
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; Department of Ambulance Service, Region Blekinge, Länsmansvägen 1, 374 41 Karlshamn, Sweden; Center of Interprofessional Collaboration within Emergency Care, Linnaeus University, Box 451, SE-351 06 Växjö, Sweden.
| | - Petra Lilja Hagell
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden
| | - Peter Hagell
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden
| | - Martin Persson
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden
| | - Mats Holmberg
- Center of Interprofessional Collaboration within Emergency Care, Linnaeus University, Box 451, SE-351 06 Växjö, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Box 451, SE-351 06 Växjö, Sweden; Department of Ambulance Service, Region Sörmland, Österleden 20, SE-641 49 Katrineholm, Sweden; Center for Clinical Research Sörmland, Uppsala University, Mälarsjukhuset, SE-631 88 Eskilstuna, Sweden
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Melmed KR, Lewis A, Kuohn L, Marmo J, Rossan-Raghunath N, Torres J, Muralidharan R, Lord AS, Ishida K, Frontera JA. Association of Neighborhood Socioeconomic Status With Withdrawal of Life-Sustaining Therapies After Intracerebral Hemorrhage. Neurology 2024; 102:e208039. [PMID: 38237088 PMCID: PMC11097759 DOI: 10.1212/wnl.0000000000208039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/07/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Mortality after intracerebral hemorrhage (ICH) is common. Neighborhood socioeconomic status (nSES) is an important social determinant of health (SDoH) that can affect clinical outcome. We hypothesize that SDoH, including nSES, contribute to differences in withdrawal of life-sustaining therapies (WLSTs) and mortality in patients with ICH. METHODS We performed a retrospective study of patients with ICH at 3 tertiary care hospitals between January 2017 and December 2022 identified through the Get with the Guidelines Database. We collected data on age, clinical severity, race/ethnicity, median household income, insurance, marital status, religion, mortality before discharge, and WLST from the electronic medical record. We assessed for associations between SDoH and WLST, mortality, and poor discharge mRS using Mann-Whitney U tests and χ2 tests. We performed multivariable analysis using backward stepwise logistic regression. RESULTS We identified 868 patients (median age 67 [interquartile range (IQR) 55-78] years; 43% female) with ICH. Of them, 16% were Black non-Hispanic, 17% were Asian, and 15% were of Hispanic ethnicity; 50% were on Medicare and 22% on Medicaid, and the median (IQR) household income was $81,857 ($58,669-$122,078). Mortality occurred in 17% of patients, and of them, 84% of patients had WLST. Patients from zip codes with higher median household incomes had higher incidence of WLST and mortality (p < 0.01). Black non-Hispanic race was associated with lower WLST and discharge mortality (p ≤ 0.01 for both). In multivariable analysis adjusting for age and clinical severity scores, patients who lived in zip codes with high-income levels were more likely to have WLST (adjusted odds ratio [aOR] 1.88; 95% CI 1.29-2.74) and mortality before discharge (aOR 1.5; 95% CI 1.06-2.13). DISCUSSION SDoH, including nSES, are associated with WLST after ICH. This has important implications for the care and management of patients with ICH.
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Affiliation(s)
- Kara R Melmed
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Ariane Lewis
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Lindsey Kuohn
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Joanna Marmo
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Nirmala Rossan-Raghunath
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Jose Torres
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Rajanandini Muralidharan
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Aaron S Lord
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Koto Ishida
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
| | - Jennifer A Frontera
- From the Departments of Neurology and Neurosurgery (K.R.M., A.L.), and Neurology (L.K., J.T., R.M., A.S.L., K.I., J.A.F.), NYU Langone Health and NYU Grossman School of Medicine; and Department of Neurology (J.M., N.R.-R.), NYU Langone Health, New York
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Elmohr MM, Javed Z, Dubey P, Jordan JE, Shah L, Nasir K, Rohren EM, Lincoln CM. Social Determinants of Health Framework to Identify and Reduce Barriers to Imaging in Marginalized Communities. Radiology 2024; 310:e223097. [PMID: 38376404 PMCID: PMC10902599 DOI: 10.1148/radiol.223097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 02/21/2024]
Abstract
Social determinants of health (SDOH) are conditions influencing individuals' health based on their environment of birth, living, working, and aging. Addressing SDOH is crucial for promoting health equity and reducing health outcome disparities. For conditions such as stroke and cancer screening where imaging is central to diagnosis and management, access to high-quality medical imaging is necessary. This article applies a previously described structural framework characterizing the impact of SDOH on patients who require imaging for their clinical indications. SDOH factors can be broadly categorized into five sectors: economic stability, education access and quality, neighborhood and built environment, social and community context, and health care access and quality. As patients navigate the health care system, they experience barriers at each step, which are significantly influenced by SDOH factors. Marginalized communities are prone to disparities due to the inability to complete the required diagnostic or screening imaging work-up. This article highlights SDOH that disproportionately affect marginalized communities, using stroke and cancer as examples of disease processes where imaging is needed for care. Potential strategies to mitigate these disparities include dedicating resources for clinical care coordinators, transportation, language assistance, and financial hardship subsidies. Last, various national and international health initiatives are tackling SDOH and fostering health equity.
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Affiliation(s)
- Mohab M. Elmohr
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Zulqarnain Javed
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Prachi Dubey
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - John E. Jordan
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Lubdha Shah
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Khurram Nasir
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Eric M. Rohren
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Christie M. Lincoln
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
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Lindmark A, Eriksson M, Darehed D. Mediation Analyses of the Mechanisms by Which Socioeconomic Status, Comorbidity, Stroke Severity, and Acute Care Influence Stroke Outcome. Neurology 2023; 101:e2345-e2354. [PMID: 37940549 PMCID: PMC10752643 DOI: 10.1212/wnl.0000000000207939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Low socioeconomic status (SES) is associated with increased risk of death and disability after stroke, but interventional targets to minimize disparities remain unclear. We aim to assess the extent to which SES-based disparities in the association between low SES and death and dependency at 3 months after stroke could be eliminated by offsetting differences in comorbidity, stroke severity, and acute care. METHODS This nationwide register-based cohort study included all 72 hospitals caring for patients with acute stroke in Sweden. All patients registered with an acute ischemic stroke in the Swedish Stroke Register in 2015-2016 who were independent in activities of daily living (ADL) during stroke were included. Data on survival and SES the year before stroke were retrieved by cross-linkage with other national registers. SES was defined by education and income and categorized into low, mid, and high. Causal mediation analysis was used to study the absolute risk of death and ADL dependency at 3 months depending on SES and to what extent hypothetical interventions on comorbidities, stroke severity, and acute care would equalize outcomes. RESULTS Of the 25,846 patients in the study, 6,798 (26.3%) were dead or ADL dependent 3 months after stroke. Adjusted for sex and age, low SES was associated with an increased absolute risk of 5.4% (95% CI 3.9%-6.9%; p < 0.001) compared with mid SES and 10.1% (95% CI 8.1%-12.2%; p < 0.001) compared with high SES. Intervening to shift the distribution of all mediators among patients with low SES to those of the more privileged groups would result in absolute reductions of these effects by 2.2% (95% CI 1.2%-3.2%; p < 0.001) and 4.0% (95% CI 2.6%-5.5%; p < 0.001), respectively, with the largest reduction accomplished by equalizing stroke severity. DISCUSSION Low SES patients have substantially increased risks of death and ADL dependency 3 months after stroke compared with more privileged patient groups. This study suggests that if we could intervene to equalize SES-related differences in the distributions of comorbidity, acute care, and stroke severity, up to 40 of every 1,000 patients with low SES could be prevented from dying or becoming ADL dependent.
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Affiliation(s)
- Anita Lindmark
- From the Department of Statistics (A.L., M.E.), Umeå School of Business, Economics and Statistics, and Sunderby Research Unit (D.D.), Department of Public Health and Clinical Medicine, Umeå University, Sweden.
| | - Marie Eriksson
- From the Department of Statistics (A.L., M.E.), Umeå School of Business, Economics and Statistics, and Sunderby Research Unit (D.D.), Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - David Darehed
- From the Department of Statistics (A.L., M.E.), Umeå School of Business, Economics and Statistics, and Sunderby Research Unit (D.D.), Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Wennman I, Wijk H, Jood K, Carlström E, Fridlund B, Alsholm L, Herlitz J, Hansson PO. Fast track to stroke unit for patients not eligible for acute intervention, a case-control register study on 1066 patients. Sci Rep 2023; 13:20799. [PMID: 38012289 PMCID: PMC10682035 DOI: 10.1038/s41598-023-48007-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023] Open
Abstract
Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 45, Gothenburg, Sweden.
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 45, Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, at the University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 45, Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden
| | - Bengt Fridlund
- Centre for Interprofessional Collaboration Within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Linda Alsholm
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medicine, Geriatrics and Emergency Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Bakidou A, Caragounis EC, Andersson Hagiwara M, Jonsson A, Sjöqvist BA, Candefjord S. On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry. BMC Med Inform Decis Mak 2023; 23:206. [PMID: 37814288 PMCID: PMC10561449 DOI: 10.1186/s12911-023-02290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Providing optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient's condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting. METHODS The Swedish Trauma Registry was used to train and validate five models - Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network - in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates. RESULTS There were 75,602 registrations between 2013-2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80-0.89 and AUCPR between 0.43-0.62. CONCLUSIONS AI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.
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Affiliation(s)
- Anna Bakidou
- Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Eva-Corina Caragounis
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 15, 413 45, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden
| | - Anders Jonsson
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden
| | - Bengt Arne Sjöqvist
- Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Stefan Candefjord
- Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden
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Valentin G, Nielsen CV, Nielsen ASM, Tonnesen M, Bliksted KL, Jensen KT, Ingerslev K, Maribo T, Oestergaard LG. Bridging Inequity Gaps in Healthcare Systems While Educating Future Healthcare Professionals-The Social Health Bridge-Building Programme. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6837. [PMID: 37835107 PMCID: PMC10572531 DOI: 10.3390/ijerph20196837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
Social inequity in healthcare persists even in countries with universal healthcare. The Social Health Bridge-Building Programme aims to reduce healthcare inequities. This paper provides a detailed description of the programme. The Template for Intervention Description and Replication (TIDieR) was used to structure the description. The programme theory was outlined using elements from the British Medical Research Council's framework, including identifying barriers to healthcare, synthesising evidence, describing the theoretical framework, creating a logic model, and engaging stakeholders. In the Social Health Bridge-Building Programme, student volunteers accompany individuals to healthcare appointments and provide social support before, during, and after the visit. The programme is rooted in a recovery-oriented approach, emphasising personal resources and hope. The programme finds support in constructs within the health literacy framework. Student volunteers serve as health literacy mediators, supporting individuals in navigating the healthcare system while gaining knowledge and skills. This equips students for their forthcoming roles as healthcare professionals, and potentially empowers them to develop and implement egalitarian initiatives within the healthcare system, including initiatives that promote organisational health literacy responsiveness. The Social Health Bridge-Building Programme is a promising initiative that aims to improve equity in healthcare by addressing individual, social, and systemic barriers to healthcare. The programme's description will guide forthcoming evaluations of its impact.
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Affiliation(s)
- Gitte Valentin
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
| | - Claus Vinther Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
- Department of Clinical Social Medicine and Rehabilitation, Gødstrup Regional Hospital, 7400 Herning, Denmark
| | - Anne-Sofie Meldgaard Nielsen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
| | - Merete Tonnesen
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
| | | | - Katrine Tranberg Jensen
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
- Department of Public Health, Copenhagen University, 1353 Copenhagen, Denmark
| | - Karen Ingerslev
- Social Sundhed (Social Health), 8000 Aarhus, Denmark; (K.L.B.); (K.T.J.); (K.I.)
| | - Thomas Maribo
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
| | - Lisa Gregersen Oestergaard
- DEFACTUM, Central Denmark Region, 8000 Aarhus, Denmark; (C.V.N.); (A.-S.M.N.); (M.T.); (T.M.); (L.G.O.)
- Department of Public Health, Aarhus University, 8000 Aarhus, Denmark
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8
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Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, Dumitrascu DI, Bordeianu A, Corlatescu AD, Ciurea AV. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines 2023; 11:2617. [PMID: 37892991 PMCID: PMC10604797 DOI: 10.3390/biomedicines11102617] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/29/2023] Open
Abstract
Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.
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Affiliation(s)
- Vicentiu Mircea Saceleanu
- Neurosurgery Department, Sibiu County Emergency Hospital, 550245 Sibiu, Romania;
- Neurosurgery Department, “Lucian Blaga” University of Medicine, 550024 Sibiu, Romania
| | - Corneliu Toader
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 020022 Bucharest, Romania
| | - Horia Ples
- Centre for Cognitive Research in Neuropsychiatric Pathology (NeuroPsy-Cog), “Victor Babes” University of Medicine and Pharmacy, 300736 Timisoara, Romania
- Department of Neurosurgery, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Razvan-Adrian Covache-Busuioc
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Horia Petre Costin
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Bogdan-Gabriel Bratu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - David-Ioan Dumitrascu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Andrei Bordeianu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Antonio Daniel Corlatescu
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
| | - Alexandru Vlad Ciurea
- Department of Neurosurgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (R.-A.C.-B.); (H.P.C.); (B.-G.B.); (D.-I.D.); (A.B.); (A.D.C.); (A.V.C.)
- Neurosurgery Department, Sanador Clinical Hospital, 010991 Bucharest, Romania
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9
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Nazar E, Esmaily H, Yousefi R, Jamali J, Ghandehari K, Hashtarkhani S, Jafari Z, Shakeri MT. A Spatial Variation Analysis of In-Hospital Stroke Mortality Based on Integrated Pre-Hospital and Hospital Data in Mashhad, Iran. ARCHIVES OF IRANIAN MEDICINE 2023; 26:300-309. [PMID: 38310430 PMCID: PMC10685828 DOI: 10.34172/aim.2023.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 05/01/2022] [Indexed: 02/05/2024]
Abstract
BACKGROUND Despite significant advances in the quality and delivery of specialized stroke care, there still persist remarkable spatial variations in emergency medical services (EMS) transport delays, stroke incidence, and its outcomes. Therefore, it is very important to investigate the possible geographical variations of in-hospital stroke mortality and to identify its associated factors. METHODS This historical cohort study included suspected stroke cases transferred to Ghaem Hospital of Mashhad by the EMS from March 2018 to March 2019. Using emergency mission IDs, the pre-hospital emergency data were integrated with the patient medical records in the hospital. We used the Bayesian approach for estimating the model parameters. RESULTS Out of 301 patients (142 (47.2%) females vs. 159 (52.8%) males) with a final diagnosis of stroke, 61 (20.3%) cases had in-hospital mortality. Results from Bayesian spatial log-logistic proportional odds (PO) model showed that age (PO=1.07), access rate to EMS (PO=0.78), arrival time (evening shift vs. day shift, PO=0.09), and sequelae variables (PO=9.20) had a significant association with the odds of in-hospital stroke mortality (P<0.05). Furthermore, the odds of in-hospital stroke mortality were higher in central urban areas compared to suburban areas. CONCLUSION Marked regional variations were found in the odds of in-hospital stroke mortality in Mashhad. There was a direct association between age and odds of in-hospital stroke mortality. Hence, the prognosis of in-hospital stroke mortality could be improved by better control of hypertension, prevention of the occurrence of sequelae, increasing the access rate to EMS, and optimizing shift work schedule.
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Affiliation(s)
- Eisa Nazar
- Psychiatry and Behavioral Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Mazandaran, Iran
- Orthopedic Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, School of Public Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razieh Yousefi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Public Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kavian Ghandehari
- Neurocognitive Research Center, Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Soheil Hashtarkhani
- Center for Biomedical Informatics, Department of Pediatrics, University of Tennessee Health Science Center, Memphis, USA
| | - Zahra Jafari
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Taghi Shakeri
- Department of Biostatistics, School of Public Health, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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10
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Hellsén G, Rawshani A, Skoglund K, Bergh N, Råmunddal T, Myredal A, Helleryd E, Taha A, Mahmoud A, Hjärtstam N, Backelin C, Dahlberg P, Hessulf F, Herlitz J, Engdahl J, Rawshani A. Predicting recurrent cardiac arrest in individuals surviving Out-of-Hospital cardiac arrest. Resuscitation 2023; 184:109678. [PMID: 36581182 DOI: 10.1016/j.resuscitation.2022.109678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite improvements in short-term survival for Out-of-Hospital Cardiac Arrest (OHCA) in the past two decades, long-term survival is still not well studied. Furthermore, the contribution of different variables on long-term survival have not been fully investigated. AIM Examine the 1-year prognosis of patients discharged from hospital after an OHCA. Furthermore, identify factors predicting re-arrest and/or death during 1-year follow-up. METHODS All patients 18 years or older surviving an OHCA and discharged from the hospital were identified from the Swedish Register for Cardiopulmonary Resuscitation (SRCR). Data on diagnoses, medications and socioeconomic factors was gathered from other Swedish registers. A machine learning model was constructed with 886 variables and evaluated for its predictive capabilities. Variable importance was gathered from the model and new models with the most important variables were created. RESULTS Out of the 5098 patients included, 902 (∼18%) suffered a recurrent cardiac arrest or death within a year. For the outcome death or re-arrest within 1 year from discharge the model achieved an ROC (receiver operating characteristics) AUC (area under the curve) of 0.73. A model with the 15 most important variables achieved an AUC of 0.69. CONCLUSIONS Survivors of an OHCA have a high risk of suffering a re-arrest or death within 1 year from hospital discharge. A machine learning model with 15 different variables, among which age, socioeconomic factors and neurofunctional status at hospital discharge, achieved almost the same predictive capabilities with reasonable precision as the full model with 886 variables.
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Affiliation(s)
- Gustaf Hellsén
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Aidin Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristofer Skoglund
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Bergh
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Truls Råmunddal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anna Myredal
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Edvin Helleryd
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Amar Taha
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ahmad Mahmoud
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nellie Hjärtstam
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Charlotte Backelin
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Pia Dahlberg
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Hessulf
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- Research Centre PreHospen, University of Borås, Borås, Sweden
| | - Johan Engdahl
- Karolinska Institutet, Department of Clinical Sciences, Danderyds Hospital, Stockholm, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
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11
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Naouri D, Allain S, Fery-Lemonier E, Wolff V, Derex L, Raynaud P, Costemalle V. Social inequalities and gender differences in health care management of acute ischemic strokes in France. Eur J Neurol 2022; 29:3255-3263. [PMID: 35789144 DOI: 10.1111/ene.15490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION There are regional disparities in access to stroke units in France. Several studies have shown that living in disadvantaged areas is associated with higher frequency of stroke, worse severity at presentation, increased level of dependency, and higher mortality rates. However, few studies have explored the association between an individual's socioeconomic characteristics and stroke care. Our study aimed to determine if living standards are associated with stroke unit access for patients admitted to hospital for acute ischemic stroke. METHODS Using the EDP-Santé French administrative database, we selected all patients admitted to hospital for acute ischemic stroke between 2014 and 2017. Acute ischemic stroke corresponded to hospital stay with ICD-10 codes I63 or I64 as the main diagnosis. Multivariate logistic regression was used to identify if standard of living was associated with likelihood of admission to a stroke unit. RESULTS We identified 14 123 acute-care episodes, corresponding to 335 273 episodes in the general population when appropriately weighted. Of these, 52.9 % were admitted to a stroke unit. Being in the first (i.e., poorest) living standard quartile was associated with lower likelihood of admission to a stroke unit compared with the fourth (i.e., wealthiest) quartile, and was associated with a higher likelihood of paralysis and language disorder, and death at 1 year. CONCLUSION A low living standard was associated with lower likelihood of admission to a stroke unit as well as a greater chance of paralysis and aphasia at the end of hospitalization and a higher possibility of death at 1 year after stroke. Greater access to stroke units in disadvantaged people should be promoted.
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Affiliation(s)
- D Naouri
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - S Allain
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - E Fery-Lemonier
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - V Wolff
- Société Française de Neuro-Vasculaire (SFNV).,Service de neuro-vasculaire, Hôpital de Hautepierre, Strasbourg.,UR3072, Université de Strasbourg, Strasbourg
| | - L Derex
- Société Française de Neuro-Vasculaire (SFNV).,Stroke center, neurology department, neurological hospital, Hospices Civils de Lyon, France.,Research on Healthcare Performance (RESHAPE) U 1290 - INSERM, Université de Lyon, France
| | - P Raynaud
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
| | - V Costemalle
- Department for Research, Studies, Evaluation and Statistics (DREES), French Health and Social Affairs Ministry, Paris, France
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12
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Ebinger M, Audebert HJ. Shifting acute stroke management to the prehospital setting. Curr Opin Neurol 2022; 35:4-9. [PMID: 34799513 DOI: 10.1097/wco.0000000000001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The earlier the treatment, the better the outcomes after acute ischemic stroke. Optimizing prehospital care bears potential to shorten treatment times. We here review the recent literature on mothership vs. drip-and-ship as well as mobile stroke unit concepts. RECENT FINDINGS Mobile stroke units result in the shortest onset-to-treatment times in mostly urban settings. SUMMARY Future research should focus on further streamlining processes around mobile stroke units, especially improving dispatch algorithms and improve referral for endovascular therapy.
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Affiliation(s)
- Martin Ebinger
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle
| | - Heinrich J Audebert
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin
- Klinik für Neurologie mit Experimenteller Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Germany
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13
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2295] [Impact Index Per Article: 1147.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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14
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de Havenon A, Sheth K, Johnston KC, Delic A, Stulberg E, Majersik J, Anadani M, Yaghi S, Tirschwell D, Ney J. Acute Ischemic Stroke Interventions in the United States and Racial, Socioeconomic, and Geographic Disparities. Neurology 2021; 97:e2292-e2303. [PMID: 34649872 PMCID: PMC8665433 DOI: 10.1212/wnl.0000000000012943] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 09/27/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In patients with ischemic stroke (IS), IV alteplase (tissue plasminogen activator [tPA]) and endovascular thrombectomy (EVT) reduce long-term disability, but their utilization has not been fully optimized. Prior research has also demonstrated disparities in the use of tPA and EVT specific to sex, race/ethnicity, socioeconomic status, and geographic location. We sought to determine the utilization of tPA and EVT in the United States from 2016-2018 and if disparities in utilization persist. METHODS This is a retrospective, longitudinal analysis of the 2016-2018 National Inpatient Sample. We included adult patients who had a primary discharge diagnosis of IS. The primary study outcomes were the proportions who received tPA or EVT. We fit a multivariate logistic regression model to our outcomes in the full cohort and also in the subset of patients who had an available baseline National Institutes of Health Stroke Scale (NIHSS) score. RESULTS The full cohort after weighting included 1,439,295 patients with IS. The proportion who received tPA increased from 8.8% in 2016 to 10.2% in 2018 (p < 0.001) and who had EVT from 2.8% in 2016 to 4.9% in 2018 (p < 0.001). Comparing Black to White patients, the odds ratio (OR) of receiving tPA was 0.82 (95% confidence interval [CI] 0.79-0.86) and for having EVT was 0.75 (95% CI 0.70-0.81). Comparing patients with a median income in their zip code of ≤$37,999 to >$64,000, the OR of receiving tPA was 0.81 (95% CI 0.78-0.85) and for having EVT was 0.84 (95% CI 0.77-0.91). Comparing patients living in a rural area to a large metro area, the OR of receiving tPA was 0.48 (95% CI 0.44-0.52) and for having EVT was 0.92 (95% CI 0.81-1.05). These associations were largely maintained after adjustment for NIHSS, although the effect size changed for many of them. Contrary to prior reports with older datasets, sex was not consistently associated with tPA or EVT. DISCUSSION Utilization of tPA and EVT for IS in the United States increased from 2016 to 2018. There are racial, socioeconomic, and geographic disparities in the accessibility of tPA and EVT for patients with IS, with important public health implications that require further study.
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Affiliation(s)
- Adam de Havenon
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA.
| | - Kevin Sheth
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Karen C Johnston
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Alen Delic
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Eric Stulberg
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Jennifer Majersik
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Mohammad Anadani
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - Shadi Yaghi
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - David Tirschwell
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
| | - John Ney
- From the University of Utah (A.d.H., A.D., E.S., J.M.), Salt Lake City; Yale University (K.S.), New Haven, CT; University of Virginia (K.C.J.), Charlottesville; Washington University (M.A.), St. Louis, MO; Brown University (S.Y.), Providence, RI; University of Washington (D.T.), Seattle; and Boston University (J.N.), MA
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2963] [Impact Index Per Article: 987.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Salwi S, Kelly KA, Patel PD, Fusco MR, Mistry EA, Mistry AM, Chitale RV. Neighborhood Socioeconomic Status and Mechanical Thrombectomy Outcomes. J Stroke Cerebrovasc Dis 2020; 30:105488. [PMID: 33276300 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE Our study aimed to assess the impacts of neighborhood socioeconomic status on mechanical thrombectomy (MT) outcomes for acute ischemic stroke (AIS). METHODS We conducted a prospective observational study of consecutive adult AIS patients treated with MT at one US comprehensive stroke center from 2012 to 2018. A composite neighborhood socioeconomic score (nSES) was created using patient home address, median household income, percentage of households with interest, dividend, or rental income, median value of housing units, percentage of persons 25 or older with high school degrees, college degrees or holding executive, managerial or professional specialty occupations. Using this score, patients were divided into low, middle and high nSES tertiles. Outcomes included 90-day functional independence, in-hospital mortality, length of hospital stay, discharge location, time to recanalization, successful recanalization, and symptomatic intracranial hemorrhage (sICH). RESULTS 328 patients were included. Between the three nSES groups, proportion of White patients, time-to-recanalization and admission NIH stroke scale differed significantly (p<0.05). Patients in the high nSES tertile were more likely to be functionally dependent at 90 days (unadjusted OR, 95% CI, 1.91 [1.10, 3.36]) and were less likely to die in the hospital (unadjusted OR, 95% CI, 0.46, [0.20, 0.98]). Further, patients in the high nSES tertile had decreased times to recanalization (median time in minutes, low=335, mid=368, high=297, p=0.04). However, after adjusting for variance in race and severity of stroke, the differences in clinical outcomes were not significant. CONCLUSION This study highlights how unadjusted neighborhood socioeconomic status is significantly associated with functional outcome, mortality, and time-to-recanalization following MT for AIS. Since adjustment modifies the significant association, the socioeconomic differences may be influenced by differences in pre-hospital factors that drive severity of stroke and time to recanalization. Better understanding of the interplay of these factors may lead to timelier evaluation and improvement in patient outcomes.
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Affiliation(s)
- Sanjana Salwi
- School of Medicine, Vanderbilt University, Nashville, TN, United States.
| | - Katherine A Kelly
- School of Medicine, Vanderbilt University, Nashville, TN, United States.
| | - Pious D Patel
- School of Medicine, Vanderbilt University, Nashville, TN, United States.
| | - Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Eva A Mistry
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Akshitkumar M Mistry
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Rohan V Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, United States.
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Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207392. [PMID: 33050565 PMCID: PMC7600419 DOI: 10.3390/ijerph17207392] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 09/29/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023]
Abstract
We analyzed the associations between area-level socioeconomic status (SES) and prehospital delay in acute ischemic stroke (AIS) patients by degree of urbanization with the use of an ecological framework. The participants were 13,637 patients over 18 years of age who experienced AIS from 2007 to 2012 and were admitted to any of the 29 hospitals in South Korea. Area-level SES was determined using 11 variables from the 2010 Korean census. The primary outcome was a prehospital delay (more than three hours from AIS onset time). Multilevel logistic regression was conducted to define the associations of individual- and area-level SES with prehospital delay after adjusting for confounders, which includes the use of emergency medical services (EMS) and individual SES. After adjusting for covariates, it was found that the area-level SES and urbanization were not associated with prehospital delay and EMS use was beneficial in both urban and rural areas. However, after stratification by urbanization, low area-level SES was significantly associated with a prehospital delay in urban areas (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 1.04–1.47) but not in rural areas (aOR 1.04, 95% CI 0.78–1.38). Therefore, we posit that area-level SES in urban areas might be a significant barrier to improving prehospital delay in AIS patients.
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