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Introduction: Although urban and rural differences in care or outcomes are pervasive in many areas of medicine, little is known whether processes of acute ischemic stroke (AIS) care or outcomes are different between urban and rural patients in China.Methods: We analyzed China National Stroke Registry II data from June 2012 to January 2013. Urban and rural patients were classified by insurance types of urban basic medical insurance schemes and new rural cooperative medical schemes. Processes of care were examined by 13 individual national guideline-recommended indicators and composite score. Patients’ outcomes included all-cause death, stroke recurrence, and disability (modified Rankin Score ≥3) at 3, 6 and 12 month after discharge. Propensity score matching was used to balance the baseline characteristics. Cox model with shared frailty model and logistic regression with generalized estimating equation were employed to analyze the outcomes.Results: Among 19 604 AIS patients, there were 7747 (39.5%) rural and 10 021 (51.1%) urban patients. After matching, 5231 pairs of rural and urban subjects were analyzed. Totally, urban and rural patients had similar processes of care composite score (0.76±0.18 versus 0.77±0.18) (Figure 1). However, comparing to urban patients, rural patients had higher hazard of stroke recurrence and death at 3, 6 and 12 months, and higher odds of disability at 3 months (Table 1).Conclusions: Processes of care were similar between urban and rural patients with AIS. However, rural AIS patients had worse unfavorable clinical outcomes after discharge. Difference of stroke care after discharge should be further explored among rural and urban AIS patients.