Trends in access to stroke units and early case fatality in France – 2009-2014

M Istvan 1 C Lecoffre 1 Sahar Bayat 1 V Olié C De Peretti Y Béjot Olivier Grimaud 1
1 REPERES - Recherche en Pharmaco-épidémiologie et Recours aux Soins
Abstract : Background - Stroke units (SU) improve survival and decrease disability. Issued in 2010 the French national stroke plan recommended increasing access to SU and as a result their number rose from 87 to 117 between 2010 and 2012. Our objective was to analyze trends in care, case mix and early case fatality in a period of SU deployment. Methods - We used national hospital database to identify stroke patients discharged from hospitals between 2009 and 2014. We analyzed trends in SU admission and early (7 days) case fatality adjusting for age sex and comorbidy using logistic and Poisson regression. Results - Hospital stroke admissions rose from 93 728 in 2009 to 109 456 in 2014. The proportion of patients admitted in SU nearly doubled during the period (from 23 to 44%). This was mainly attributable to more admissions of patients residing in medium and small towns. The mean age of ‘‘SU patients’’ remained below that of others but increased significantly faster over the study period (+2.5 years compared to + 1; p < 10-3). After accounting for age, stroke type and comorbidity, women remained less likely to be admitted to SU (OR for year 2014=0.89 95%CI: 0.87;0.92). Crude 7 days case fatality decreased from 9.3% in 2009 to 8.1% in 2014 (annual trend= -2.37% 95%CI:-1.88;-2.85). Most of this trend was attributable to the increasing proportion of patients admitted in SU for whom early case fatality was more than halved (adjusted rate ratio: 0.44; 95% CI: 0.43-0.45). Conclusions - Although in 2014 less than half of stroke patients in France were admitted to SU, deployment of the latter has improved access to older patients and to those residing outside major urban areas. More work is required to explain the persisting gender gap in SU admission and to measure how much the reduction in early case fatality translates into longer term benefits to patients.
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Submitted on : Friday, December 22, 2017 - 4:22:24 PM
Last modification on : Monday, January 13, 2020 - 6:16:02 PM

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M Istvan, C Lecoffre, Sahar Bayat, V Olié, C De Peretti, et al.. Trends in access to stroke units and early case fatality in France – 2009-2014. European Journal of Public Health, Oxford University Press (OUP): Policy B - Oxford Open Option D, 2017, 27 (suppl 3), pp.ckx187.386. ⟨10.1093/eurpub/ckx187.386⟩. ⟨hal-01671818⟩

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