Canadian stroke victims at higher risk of dying in rural hospitals

According to a new study published by Laval University researchers, Canadians who suffer a stroke have a higher risk of dying if they are treated in a rural hospital rather than an urban one. The mortality rate in the months that follow a stroke is approximately 25 per cent higher for patients treated in rural areas.

 The team, led by Dr. Richard Fleet, Laval Faculty of Medicine professor and holder of the Laval University-CISSS Chaudière-Appalaches research chair in emergency medicine, came to that conclusion after comparing the mortality rate of stroke victims admitted to 286 rural hospitals and 24 urban hospitals in Canada between 2007 and 2011. Rural hospitals were included in the study if they were located in a community of about 10,000 residents or less and provided 24/7 emergency-physician coverage and inpatient beds for acute admissions.

Using data compiled by the Canadian Institute for Health Information, the researchers established that the mortality rate of stroke victims admitted to urban hospitals fluctuated between 14.1 and 16.8 per cent in the five years covered by the study. In rural hospitals, that rate varied from 18.3 to 21 per cent. The discrepancy between the two types of hospitals was observed every year and in every province surveyed.

According to the researchers, the divide could be due to a lack of resources in rural hospitals. The study reports that only 21 per cent of such hospitals have an intensive care unit and scarcely 11 per cent have a CT scanner.

“Not having this device on hand in the hospital deprives doctors of a tool that can help them quickly diagnose a stroke so they can immediately begin the recommended treatment,” said Dr. Fleet.

Rural hospital emergency rooms log more than three million visits every year in Canada and strokes are one of the main causes of death in the country.

“Some 20 per cent of Canadians live in rural areas and our study raises questions about the principles of our universal healthcare system, which stipulate that all Canadians, regardless of their place of residence, have an equal right to quality health care,” said Dr. Fleet. “It might be time to address the iniquities in health care in rural areas.”

Quebec hospitals were not included in the analyses because the province did not provide data to the Canadian Institute for Health Information for the study period. However, a previous study by the team indicated Quebec’s rural hospitals are well equipped compared to those in the rest of Canada: 74 per cent have an intensive care unit and 78 per cent have a CT scanner.

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