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Impact of macroeconomic status on prehospital management, in-hospital care and functional outcome of acute stroke in China

R Ji, D Wang, G Liu, H Shen, Y Wang, H Li, LH Schwamm, Y Wang

Aim: To examine the association between gross regional product (GRP) per capita and prehospital management, in-hospital quality of care and functional outcome after stroke.

Methods: The study was based on the China National Stroke Registry between 2007 and 2008. Based on the average GRP per capita in 2008, provinces in China were divided into developed and underdeveloped areas. Two variables and ten performance measures were used as quality indicators for prehospital management and in-hospital care, respectively. Good functional outcome was defined as a modified Rankin Scale score ≤2 at discharge. A summary composite measure was calculated by using an opportunity-based score. A generalized estimation equation was performed to adjust for confounders.

Results: For ischemic stroke (acute ischemic stroke/transient ischemic attack), compared with patients in the underdeveloped area (n = 7573), those in the developed area (n = 8516) received better prehospital management (adjusted odds ratio [OR]: 1.03; 95% CI: 1.02–1.04; p < 0.001) and a higher quality of in-hospital care (adjusted OR: 1.02; 95% CI: 1.01–1.03; p < 0.001). Higher GRP per capita was significantly associated with better functional outcome (modified Rankin Scale score ≤2) at discharge after ischemic stroke (adjusted OR: 1.11; 95% CI: 1.02–1.20; p < 0.001). A similar association between GRP per capita and prehospital management (p < 0.001) and primary outcome (p < 0.001) was found for hemorrhagic stroke (subarachnoid hemorrhage/intracranial hemorrhage).

Conclusion: Higher GRP per capita was associated with better prehospital, in-hospital quality of stroke care and functional outcome at discharge after acute stroke.