Regional Deprivation, Stroke Incidence, and Stroke Care—An Analysis of Billing and Quality Assurance Data From the German State of Rhineland-Palatinate
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Regional Deprivation, Stroke Incidence, and Stroke Care—An Analysis of Billing and Quality Assurance Data From the German State of Rhineland-Palatinate. / Grau, Armin J; Dienlin, Sieghard; Bartig, Dirk; Maier, Werner; Buggle, Florian; Becher, Heiko.
In: DTSCH ARZTEBL INT, Vol. 118, No. 23, 11.06.2021, p. 397-402.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Regional Deprivation, Stroke Incidence, and Stroke Care—An Analysis of Billing and Quality Assurance Data From the German State of Rhineland-Palatinate
AU - Grau, Armin J
AU - Dienlin, Sieghard
AU - Bartig, Dirk
AU - Maier, Werner
AU - Buggle, Florian
AU - Becher, Heiko
PY - 2021/6/11
Y1 - 2021/6/11
N2 - BACKGROUND: Regional deprivation can increase the risk of illness and adversely affect care outcomes. In this study, we investigated for the German state of Rhineland-Palatinate whether spatial-structural disadvantages are associated with an increased frequency of ischemic stroke and with less favorable care outcomes.METHODS: We compared billing data from DRG statistics (2008-2017) and quality assurance data (2017) for acute ischemic stroke with the German Index of Multiple Deprivation 2010 (GIMD 2010) for the 36 districts (Landkreise) and independent cities (i.e., cities not belonging to a district) in Rhineland-Palatinate using correlation analyses, a Poisson regression analysis, and logistic regression analyses.RESULTS: The age-standardized stroke rates (ASR) ranged from 122 to 209 per 100 000 inhabitants, while the GIMD 2010 ranged from 4.6 to 47.5; the two values were positively correlated (Spearman's ρ = 0.47; 95% confidence interval [0.16; 0.85]). In 2017, mechanical thrombectomies were performed more commonly (5.7%) in the first GIMD 2010 quartile of the regional areas (i.e., in the least deprived areas) than in the remaining quartiles (4.2-4.6%). The intravenous thrombolysis rates showed no differences from one GIMD 2010 quartile to another. Severe neurological deficits (National Institutes of Health Stroke Scale ≥ 5) on admission to the hospital were slightly more common in the fourth quartile (i.e., in the most deprived areas), while antiplatelet drugs and statins were somewhat less commonly ordered on discharge in those areas than in the first quartile.CONCLUSION: These findings document a relationship between regional deprivation and the occurrence of acute ischemic stroke. Poorer GIMD 2010 scores were associated with worse care outcomes in a number of variables, but the absolute differences were small.
AB - BACKGROUND: Regional deprivation can increase the risk of illness and adversely affect care outcomes. In this study, we investigated for the German state of Rhineland-Palatinate whether spatial-structural disadvantages are associated with an increased frequency of ischemic stroke and with less favorable care outcomes.METHODS: We compared billing data from DRG statistics (2008-2017) and quality assurance data (2017) for acute ischemic stroke with the German Index of Multiple Deprivation 2010 (GIMD 2010) for the 36 districts (Landkreise) and independent cities (i.e., cities not belonging to a district) in Rhineland-Palatinate using correlation analyses, a Poisson regression analysis, and logistic regression analyses.RESULTS: The age-standardized stroke rates (ASR) ranged from 122 to 209 per 100 000 inhabitants, while the GIMD 2010 ranged from 4.6 to 47.5; the two values were positively correlated (Spearman's ρ = 0.47; 95% confidence interval [0.16; 0.85]). In 2017, mechanical thrombectomies were performed more commonly (5.7%) in the first GIMD 2010 quartile of the regional areas (i.e., in the least deprived areas) than in the remaining quartiles (4.2-4.6%). The intravenous thrombolysis rates showed no differences from one GIMD 2010 quartile to another. Severe neurological deficits (National Institutes of Health Stroke Scale ≥ 5) on admission to the hospital were slightly more common in the fourth quartile (i.e., in the most deprived areas), while antiplatelet drugs and statins were somewhat less commonly ordered on discharge in those areas than in the first quartile.CONCLUSION: These findings document a relationship between regional deprivation and the occurrence of acute ischemic stroke. Poorer GIMD 2010 scores were associated with worse care outcomes in a number of variables, but the absolute differences were small.
KW - Brain Ischemia
KW - Humans
KW - Incidence
KW - Regression Analysis
KW - Stroke/epidemiology
UR - https://pubmed.ncbi.nlm.nih.gov/33663687/
U2 - 10.3238/arztebl.m2021.0149
DO - 10.3238/arztebl.m2021.0149
M3 - SCORING: Journal article
C2 - 33663687
VL - 118
SP - 397
EP - 402
JO - DTSCH ARZTEBL INT
JF - DTSCH ARZTEBL INT
SN - 1866-0452
IS - 23
ER -