Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry

Diandian Huang; Yuxuan Lu; Yongan Sun; Wei Sun; Yining Huang; Liwen Tai; Guozhong Li; Huisheng Chen; Guiru Zhang; Lei Zhang; Xuwen Sun; Jinhua Qiu; Yan Wei; Haiqiang Jin

doi:10.3389/fneur.2023.1206846

Effect of weekend versus weekday admission on the mortality of acute ischemic stroke patients in China: an analysis of data from the Chinese acute ischemic stroke treatment outcome registry

Front Neurol. 2023 Jul 17:14:1206846. doi: 10.3389/fneur.2023.1206846. eCollection 2023.

Authors

Diandian Huang¹, Yuxuan Lu¹, Yongan Sun¹, Wei Sun¹, Yining Huang¹, Liwen Tai², Guozhong Li³, Huisheng Chen⁴, Guiru Zhang⁵, Lei Zhang⁶, Xuwen Sun⁷, Jinhua Qiu⁸, Yan Wei⁹, Haiqiang Jin¹

Affiliations

¹ Department of Neurology, Peking University First Hospital, Beijing, China.
² Department of Neurology, Second Hospital of Hebei Medical University, Shijiazhuang, China.
³ Department of Neurology, First Affiliated Hospital of Harbin Medical University, Neurology, Harbin, China.
⁴ Department of Neurology, The General Hospital of Shenyang Military Command, Shenyang, China.
⁵ Department of Neurology, Penglai People's Hospital, Penglai, China.
⁶ Department of Neurology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁷ Department of Neurology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China.
⁸ Department of Neurology, Huizhou First Hospital, Huizhou, China.
⁹ Department of Neurology, Harrison International Peace Hospital, Hengshui, China.

Abstract

Background: Due to disparities in medical resources in rural and urban areas as well as in different geographic regions in China, the effect of weekend versus weekday admission on the outcomes of acute ischemic stroke (AIS) patients is unknown. Our aim was to investigate whether the outcomes of AIS patients differ according to the day of admission in China.

Methods: The data were extracted from the Chinese Acute Ischemic Stroke Treatment Outcome Registry (CASTOR), a multicenter prospective study database of patients diagnosed with AIS. The chi-square test (χ²) and logistic regression were used to assess mortality for weekday and weekend admissions among AIS patients stratified by rural or urban status and geographic region (including the eastern, northeastern, central, and western regions).

Results: In total, 9,256 patients were included in this study. Of these patients, 57.2% were classified as urban, and 42.8% were classified as rural. A total of 6,760 (73%) patients were admitted on weekdays, and 2,496 (27%) were admitted on weekends. There was no significant difference in the mortality rate among patients admitted on weekends compared with those admitted on weekdays in urban (7.5% versus 7.4%) or rural areas (8.8% versus 8.1%; p > 0.05). The mortality rate was the highest among patients admitted on weekends and weekdays (11.6% versus 10.3%) in the northeastern area, without statistical significance before and after adjusting for the patients' background characteristics (p > 0.05). In addition, regression analysis revealed that the mortality of patients admitted on weekdays was more likely to be influenced by regional subgroup, hospital level and intravenous thrombolysis than that of patients admitted on weekends.

Conclusion: The weekend effect was not observed in the mortality of patients with AIS regardless of rural-urban status or geographic region in China.

Keywords: China; acute ischemic stroke; mortality; regional difference; rural; weekend.