Age and geographic disparities in acute ischaemic stroke prehospital delays in China: a cross-sectional study using national stroke registry data

Jing Yuan; Z Kevin Lu; Xiaomo Xiong; Minghui Li; Yang Liu; Long-De Wang; Renyu Liu; Jing Zhao

doi:10.1016/j.lanwpc.2023.100693

Age and geographic disparities in acute ischaemic stroke prehospital delays in China: a cross-sectional study using national stroke registry data

Lancet Reg Health West Pac. 2023 Jan 16:33:100693. doi: 10.1016/j.lanwpc.2023.100693. eCollection 2023 Apr.

Authors

Jing Yuan¹, Z Kevin Lu², Xiaomo Xiong², Minghui Li³, Yang Liu⁴, Long-De Wang⁵, Renyu Liu⁶, Jing Zhao⁴

Affiliations

¹ Department of Clinical Pharmacy, School of Pharmacy, Fudan University, 826 Zhangheng Road, Pudong District, Shanghai, 201203, PR China.
² Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, 715 Sumter Street, CLS Building 311, Columbia, SC, 29208, USA.
³ Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis TN, USA.
⁴ Department of Neurology, Minhang Hospital, Fudan University, 170 Xinsong Road, Shanghai, 201100, PR China.
⁵ The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, 100053, PR China.
⁶ Departments of Anesthesiology and Critical Care, and Neurology, Perelman School of Medicine at the University of Pennsylvania, 336 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA, 19104, USA.

Abstract

Background: Stroke has been the leading cause of death in China for decades. The extremely low intravenous thrombolysis rate is largely due to the prehospital delays that make patients ineligible for the time-sensitive therapy. Limited studies evaluated prehospital delays across China. We investigated prehospital delays in the stroke population across China and the associated age, rurality, and geographic disparities.

Methods: A cross-sectional study design was employed using the Bigdata Observatory platform for Stroke of China in 2020, the nationwide, prospective, multicentre registry of patients with acute ischaemic stroke (AIS). Mixed-effect regression models were used to account for the clustered data.

Findings: The sample contained 78,389 AIS patients. The median onset-to-door (OTD) time was 24 h, with only 11.79% (95% confidence interval [CI]: 11.56-12.02%) patients arriving at hospitals within 3 h. About 12.43% (95% CI: 12.11-12.74%) of patients 65 years or older arrived at hospitals within 3 h, which was significantly higher than the young and middle-aged patients (11.03%; 95% CI: 10.71-11.36%). After controlling for potential confounders, young and middle-aged patients were less likely to present to hospitals within 3 h (adjusted odds ratio: 0.95; 95% CI: 0.90-0.99) compared to patients 65 years or older. The 3-h hospital arrival rate was the highest in Beijing (18.40%, 95% CI: 16.01-20.79%), which was almost 5 times higher than that in Gansu (3.45%, 95% CI: 2.69-4.20%). The arrival rate in urban areas was almost 2 times higher than that in rural areas (13.35% versus. 7.66%).

Interpretation: We found that the low rates of timely arrival at hospitals after a stroke is more salient in the younger population, rural settings, or those residing in less developed geographic regions. This study calls for more tailored interventions focusing on younger people, rural areas, and less developed geographic regions.

Funding: The National Natural Science Foundation of China; CIHR, Grant/Award Number: 81973157, PI: JZ. Natural Science Foundation of Shanghai; CIHR, Grant/Award Number: 17dz2308400, PI: JZ. Funding from the University of Pennsylvania; Grant/Award Number: CREF-030, PI: RL.

Keywords: Acute ischaemic stroke; Age; Bigdata observatory platform for stroke of China; Geographic; Onset-to-door; Prehospital delay; Rural.