Stroke victims do better in urban areas

Université Laval data raises questions about universal health care in rural areas

Rural living may be touted as better for your health than life in the city, but if you suffer a stroke, your chances of dying are significantly higher, according to a Quebec study comparing urban and regional hospitals.

A Université Laval study published in PLOS ONE in January found the risk of dying from a stroke is approximately 25 per cent higher for patients treated in rural areas across Canada, excluding Quebec.

That’s because many rural hospitals lack resources and access to health care, researchers said. Only 11 per cent of rural hospitals had diagnostic equipment such as a CT scanner, one per cent had MRI machines, 21 per cent had an intensive care unit (ICU), 94 per cent had a laboratory and 92 per cent had basic X-ray facilities, the study found.

A team headed by Dr. Richard Fleet, who holds the chair in medical emergency research at Université Laval, analyzed the death rates in the months following strokes among patients admitted to 286 regional hospitals and 24 urban hospitals, based on Canadian Institute for Health Information (CIHI) data from 2007 to 2011. Rural hospitals were included in the study if they were located in communities with 10,000 residents or less and provided 24/7 emergency physician coverage and admitted patients.

Fleet, who has seen firsthand the effects of meagre resources on emergency medicine when he worked as a young doctor in the small town of Nelson, B.C., said his team was not surprised the study found rural patients fared worse than those in urban centres.

“But we were surprised that in the literature this is not documented,” Fleet said.

The study raises questions about universal health care for the 20 per cent of Canadians who live in rural settings. A national effort is now underway with many physicians, hospitals and communities advocating to restore services to rural areas, Fleet said.

“But there are not many studies describing what’s out there. And if you can show differential outcomes, you get people thinking about reducing those gaps.”

Canadian hospital emergency rooms register more than three million visits each year and strokes are one of three main causes of death. A CT scan is crucial to its diagnosis.

Quebec was not included in the study because it did not provide CIHI with data.

However, Fleet noted that the province provides better health services in its regions than most Canadian rural hospitals. An earlier study published in BMC Health Services, an open data journal, shows that of Quebec’s 26 rural

Most rural hospitals don’t meet recent standards for acute stroke care, potentially resulting in poorer outcomes.

hospitals, 74 per cent had a CT scanner and 78 per cent had an intensive care unit and general surgical services. Also, rural teams are often connected via tele-health to specialty doctors in urban centres.

According to the Heart and Stroke Foundation of Canada, patients arriving in the emergency room with stroke symptoms should have a CT scan done as quickly as possible to assess whether clot-busting medication should be started to minimize brain damage and other consequences.

“With stroke, the saying is ‘time is brain.’ Every minute that passes, cells in your brain die. You want a diagnosis and medication,” Fleet said.

“Most rural hospitals don’t meet recent standards for acute stroke care, potentially resulting in poorer outcomes than better-staffed and equipped academic urban hospitals.” These inequities need to be addressed, Fleet said.