• Armin J Grau, Sieghard Dienlin, Dirk Bartig, Werner Maier, Florian Buggle, and Heiko Becher.
• Department of Neurology, Ludwigshafen Hospital, Ludwigshafen; Quality Assurance Agency of Rhineland-Palatinate, Mainz; DRG Market, Osnabrück; Helmholtz Center Munich - German Research Center for Health and the Environment (Ltd), Institute for Health Economics and Management in Healthcare, Neuherberg; Oberwallis Hospital Center, Visp, Switzerland; Institute for Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg.
• Dtsch Arztebl Int. 2021 Jun 11; 118 (23): 397-402.

BackgroundRegional deprivation can increase the risk of illness and adversely affect care outcomes. In this study, we investigated for the German state of Rhineland-Palatinate whether spatial-structural disadvantages are associated with an increased frequency of ischemic stroke and with less favorable care outcomes.MethodsWe compared billing data from DRG statistics (2008-2017) and quality assurance data (2017) for acute ischemic stroke with the German Index of Multiple Deprivation 2010 (GIMD 2010) for the 36 districts (Landkreise) and independent cities (i.e., cities not belonging to a district) in Rhineland-Palatinate using correlation analyses, a Poisson regression analysis, and logistic regression analyses.ResultsThe age-standardized stroke rates (ASR) ranged from 122 to 209 per 100 000 inhabitants, while the GIMD 2010 ranged from 4.6 to 47.5; the two values were positively correlated (Spearman's ρ = 0.47; 95% confidence interval [0.16; 0.85]). In 2017, mechanical thrombectomies were performed more commonly (5.7%) in the first GIMD 2010 quartile of the regional areas (i.e., in the least deprived areas) than in the remaining quartiles (4.2-4.6%). The intravenous thrombolysis rates showed no differences from one GIMD 2010 quartile to another. Severe neurological deficits (National Institutes of Health Stroke Scale ≥ 5) on admission to the hospital were slightly more common in the fourth quartile (i.e., in the most deprived areas), while antiplatelet drugs and statins were somewhat less commonly ordered on discharge in those areas than in the first quartile.ConclusionThese findings document a relationship between regional deprivation and the occurrence of acute ischemic stroke. Poorer GIMD 2010 scores were associated with worse care outcomes in a number of variables, but the absolute differences were small.

7 keywords...

hide…