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Rural Stroke Patients Less Likely To Survive, Wash U Study Finds

Rural residents who have a stroke are less likely to receive advanced treatment options and about 20% more likely to die at the hospital compared to urban patients, according to research from Washington University.
Hanna Barczyk | NPR
Rural residents in the U.S. who have a stroke are less likely to receive advanced treatment options and about 20% more likely to die at the hospital compared to urban patients, according to research from Washington University.

Stroke patients in rural hospitals fare far worse than urban patients, according to new research from Washington University.

Based on the records of nearly 800,000 stroke patients in the U.S. collected over six years, rural residents were less likely to receive advanced, lifesaving treatments than urban patients — and more likely to die at the hospital.

The gap in life expectancy between rural and urban residents nationwide has widened over the past decade, with city dwellers living longer on average than those in more remote areas. 

Rural residents in the U.S. tend to be older, sicker and less likely to have health insurance than people living in cities. Meanwhile, the hospitals that serve them are facing an “increasingly uphill battle,” said Washington University cardiologist Karen Joynt Maddox.

“We know that rural areas have a harder time keeping hospitals open and attracting specialists,” said Maddox, who co-authored the study. “Rural hospitals are struggling to stay afloat, and that’s been the case for a long time.”

Stroke treatment technology lags in rural hospitals

Despite doctors’ best efforts, caring for stroke patients with limited hospital resources can be challenging, Maddox said.

Stroke is the fifth-leading cause of death in the U.S., occurring when either a blood vessel bursts in the brain or a clot blocks blood flow. But your chances of being killed by a stroke can depend on a range of factors, including, to some extent, where you live.

Maddox and her colleagues found patients from rural areas were more than 20% more likely to die at the hospital compared to urban residents, supporting previous findings.

Rural patients were also less likely to receive two advanced forms of stroke treatment: endovascular therapy, in which a doctor uses a tiny catheter to remove a blood clot from a person’s brain, and intravenous thrombolysis, in which a clot-busting drug is injected directly into the patient’s veins. 

“As this new technology is taken up, it gets put in places that already have the infrastructure for it — the places that have interventional radiologists and high-tech rooms and the right cameras,” Maddox said. “The places that are being left behind are the rural areas.”

But she added it’s unrealistic to expect all rural hospitals to be able to provide these advanced treatments, which often require special training and equipment. 

Instead, other forms of technology, like telehealth, could help bridge the gap in stroke care. An increasing number of emergency departments in rural hospitals now use telehealth systems to connect to urban medical centers, where remote specialists can examine a patient’s CAT scan results, talk to the patient via video and discuss treatment options with on-site staff.

Rural stroke patients who need advanced treatment should be transferred to urban centers, Maddox said, but the byzantine structure of U.S. health care complicates these efforts. 

“Our health system is not a health system; it's wonderful people working very hard in a non-system,” she said. “In a non-system, patients don't get the best possible care, because the system isn't built around them. It's built around the economics of hospitals.”

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