Abstract WP396: Effects of the Accessibility to Emergency Medical Systems on Stroke Mortality: A Nationwide Survey (J-ASPECT study)
Objective: Rapid emergency medical care for patients with acute stroke is necessary for better prognoses. To decrease the time to medical care, emergency medical systems (EMSs) and stroke centers are distributed extensively in Japan, with universal coverage of medical insurance. We examined the influence of the accessibility to EMSs on stroke mortality in Japan.
Methods: We approached 1381 certified training institutions of the Japan Neurosurgical Society and/or the Japan Stroke Society with a question survey regarding acute stroke care capacity. In institutions that responded, the data of the stroke patients hospitalized were obtained from Japanese Diagnosis Procedure Combination database of 2011. The transfer time was measured by an electronic mapping system as the time taken from the postal address of the patient to the transferred hospital. Geographical location by urban employment area (UMA) was classified into 5 categories: metropolitan employment areas (MEA) - central, MEA - outlying, micropolitan employment areas (McEA) - central, McEA - outlying, and unclassified. We examined the effects of UMA and transfer time as measures of accessibility by using a hierarchical linear regression model adjusted by age, gender, and characteristics of institutions.
Results: The data of 256 institutions and 53,170 emergency hospitalized patients were analyzed. Mortalities were as follows: 7.8% in cerebral infarction (n = 32,671); 16.8% in intracerebral hemorrhage (n = 15,699); and 28.1% in subarachnoid hemorrhage (n = 4,934). The mortality was lower in MEA - central and higher in unclassified areas for mortality in cerebral infarction (MEA - central, 7.3%; unclassified, 12.0%; OR = 1.55, 95%CI = 1.01-2.39) and subarachnoid hemorrhage (MEA - central, 26.7%; unclassified, 42.9%; OR = 1.95, 95%CI = 1.03-3.70). In areas in cerebral infarction, longer transfer time affected mortality (P = 0.027, MEA - central; P = 0.038, unclassified).
Conclusion: Stroke mortality increased according to the inaccessibility to EMS combined with UMA and transfer time. These factors should be taken into account to resolve inappropriate EMS disparities.
- © 2012 by American Heart Association, Inc.