Weekend Effect on in-Hospital Mortality for Ischemic and Hemorrhagic Stroke in US Rural and Urban Hospitals |
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| Institution: | 2. Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States;3. Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, 205D Wright Hall, Athens, GA 30602, United States;4. Department of Neurology, Wenzhou Medical University, Zhejiang, China;2. Department of Neurology, Miller School of Medicine, University of Miami, Miami, Fl, USA;3. Department of Epidemiology, Gilead Sciences, Inc., Foster City, CA, USA;4. Renaissance School of Medicine, Stony Brook University, New York, NY, USA;5. Community Center, The Atahualpa Project, Atahualpa, Ecuador;2. Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510006, China;3. Postdoctoral Center, Yangjiang Hospital of Chinese Medicine, Yangjiang 529500, China;2. Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France;3. Neurovascular Unit, Foch Hospital, Suresnes, France;4. Neurovascular Unit, Foch Hospital, Suresnes, France;5. Interventional Neuroradiology Unit, Fondation Rothschild Hospital, Paris, France; Laboratory of Vascular Translational Science, U1148 Institut National de la Santé et de la Recherche Médicale (INSERM), Paris, France; Université Paris Denis Diderot, Sorbonne Paris Cite, France;2. Department of Neurology and Stroke Program, University of Michigan, Ann Arbor, MI, United States;3. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States;4. Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States;5. VA Ann Arbor Healthcare System, University of Michigan, Ann Arbor, MI, United States |
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| Abstract: | IntroductionPrevious studies have reported a “weekend effect” on stroke mortality, whereby stroke patients admitted during weekends have a higher risk of in-hospital death than those admitted during weekdays.AimsWe aimed to investigate whether patients with different types of stroke admitted during weekends have a higher risk of in-hospital mortality in rural and urban hospitals in the US.MethodsWe used data from the 2016 National Inpatient Sample and used logistic regression to assess in-hospital mortality for weekday and weekend admissions among stroke patients aged 18 and older by stroke type (ischemic or hemorrhagic) and rural or urban status.ResultsCrude stroke mortality was higher in weekend admissions (p <0.001). After adjusting for confounding variables, in-hospital mortality among hemorrhagic stroke patients was significantly greater (22.0%) for weekend admissions compared to weekday admissions (20.2%, p = 0.009). Among rural hospitals, the in-hospital mortality among hemorrhagic stroke patients was also greater among weekend admissions (36.9%) compared to weekday admissions (25.7%, p = 0.040). Among urban hospitals, the mortality of hemorrhagic stroke patients was 21.1% for weekend and 19.6% for weekday admissions (p = 0.026). No weekend effect was found among ischemic stroke patients admitted to rural or urban hospitals.ConclusionsOur results help to understand mortality differences in hemorrhagic stroke for weekend vs. weekday admissions in urban and rural hospitals. Factors such as density of care providers, stroke centers, and patient level risky behaviors associated with the weekend effect on hemorrhagic stroke mortality need further investigation to improve stroke care services and reduce weekend effect on hemorrhagic stroke mortality. |
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