期刊
LANCET REGIONAL HEALTH-WESTERN PACIFIC
卷 20, 期 -, 页码 -出版社
ELSEVIER
DOI: 10.1016/j.lanwpc.2021.100358
关键词
Stroke; Disparities; Ethnicity; Indigenous; Health services research; Epidemiology; Outcome resarch
资金
- New Zealand Health Research Council [HRC17/037]
This study investigated ethnic inequities in stroke care access in New Zealand and found that non-European, particularly Maori, patients had poorer access to key stroke interventions and experienced worse outcomes.
Background Ethnic inequities in stroke care access have been reported internationally but the impact on outcomes remains unclear. In New Zealand, data on ethnic stroke inequities and resultant effects on outcomes are generally limited and conflicting. Methods In a prospective, nationwide, multi-centre observational study, we recruited consecutive adult patients with confirmed stroke from 28 hospitals between 1 May and 31 October 2018. Patient outcomes: favourable functional outcomes (modified Rankin Scale 0-2); quality of life (EQ-5D-3L); stroke/vascular events; and death at three, six and 12 months. Process measures: access to reperfusion therapies, stroke-units, investigations, secondary prevention, rehabilitation. Multivariate regression analyses assessed associations between ethnicity and outcomes and process measures. Findings The cohort comprised 2,379 patients (median age 78 (IQR 66-85); 51.2% male; 76.7% European, 11.5% Maori, 4.8% Pacific peoples, 4.8% Asian). Non-Europeans were younger, had more risk factors, had reduced access to acute stroke units (aOR=0.78, 95%CI, 0.60-0.97), and were less likely to receive a swallow screen within 24 hours of arrival (aOR=0.72, 0.53-0.99) or MRI imaging (OR=0.66, 0.52-0.85). Maori were less frequently prescribed anticoagulants (OR=0.68, 0.47-0.98). Pacific peoples received greater risk factor counselling. Fewer non-Europeans had a favourable mRS score at three (aOR=0.67, 0.47-0.96), six (aOR=0.63, 0.40-0.98) and 12 months (aOR=0.56, 0.36-0.88), and more Maori had died by 12 months (aOR=1.76, 1.07-2.89). Interpretation Non-Europeans, especially Maori, had poorer access to key stroke interventions and experience poorer outcomes. Further optimisation of stroke care targeting high-priority populations are needed to achieve equity. Copyright (C) 2021 The Authors. Published by Elsevier Ltd.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据