Abstract 2367: Increased Density Of Neuroscience Providers Is Associated With Decreased Risk Of Death From Stroke In The United States
Background. Stroke is a leading cause of death and disability in the United States. Given that neurologists and neurosurgeons hold special expertise in this area relative to other healthcare providers, we hypothesized that the density of neuroscience providers would be associated with reduced mortality from stroke across US counties.
Methods. The Area Resource File 2009-2010 was retrospectively analyzed. The primary outcome variable was the three-year (2004-2006) average in cerebrovascular disease deaths per million population for each county. The primary independent variable was the combined density of neurosurgeons and neurologists per million population in the year 2006. Multiple regression analysis was performed, adjusting for density of general practitioners, urbanicity of the county, and socioeconomic status of the county.
Results. The median number of annual stroke deaths per million population, in the 3139 counties analyzed, was 586 (IQR 449-754). The median number of neuroscience providers (neurologist or neurosurgeon) per million population was 0 (IQR 0-26), while the median number of general practitioners per million population was 274 (IQR 175-410). Each increase of one neuroscience provider per million population was associated with 0.71 fewer deaths from stroke per million population (p < 0.001). On multivariate adjusted analysis, each increase of one neuroscience provider per million population was associated with 0.38 fewer stroke deaths per million population (p < 0.001). Rural location (p<0.001) and increased density of general practitioners (p < 0.001), were associated with significant increases in the rate of stroke deaths, while persistent poverty and low educational levels were not significant.
Conclusions. Higher density of specialist neuroscience providers is associated with significant reduction in deaths from stroke, a major cause of mortality nationally. This suggests that the availability of specialists is an important factor in the overall likelihood of survival from stroke, and therefore underlines the importance of promoting specialist education and practice throughout the country.
- © 2012 by American Heart Association, Inc.