Study Objective: This study examines the pattern of incidence and health service utilisation of cerebrovascular disease cases in urban and rural areas within a publicly funded health care system. Design: A population-based study covering a large geographic region, using population-wide administrative health data. Age- and sex-standardised incidence and mortality rates were calculated for rural and urban areas. Final status (discharge or death), place of service and place of residence were reported for all cases across several different subsets of cerebrovascular disease. Setting: The province of Alberta, located in western Canada. Participants: Incident cases of cerebrovascular disease (stroke and transient ischaemic attack) and 4 different definitions of incident stroke were identified from data on emergency department admissions in the 1999/2000 fiscal year. Main Results: The rate of cerebrovascular disease per 10,000 was similar between urban (13.24) and rural (13.82) areas. Rural residents frequently reported their incident episode to urban emergency departments. Although the mortality is similar between urban and rural residents, rural dwellers die more frequently in the emergency department setting than urban dwellers, who die more often as in-patients. Conclusions: Overall mortality is similar between urban and rural residents. A large proportion of rural residents receive diagnoses and treatment for cerebrovascular disease in urban areas. Location of service and location of death differs between rural and urban cases of cerebrovascular disease.

Keywords:
Rural residents, Emergency department, Administrative data
1.
Lanska DT, Bachman DL, Carter TD, Barker DL, Timms S, Kohli H: The geographic variation in stroke incidence in two areas of the southeastern stroke belt: The Andersson and Pee Dee Stroke Study. Stroke 1998;29:2061–2068.
2.
Engstrom G, Jerntorp I, Pessah-Rasmussen H, Hedblad B, Berglund G, Janzon L: Geographic distribution of stroke incidence within an urban population. Stroke 2001;32:1098–1103.
3.
Starr JM, Thomas B, Whalley LJ: Population risk factors for hospitalization for stroke in Scotland. Int J Epidemiol 1996;25:276–281.
4.
Maheswaran R, Elliott P, Strachan DP: Socioeconomic deprivation, ethnicity, and stroke mortality in Greater London and south-east England. J Epidemiol Community Health 1997;51:127–131.
5.
Adam DJ, Bain M, Shanks E, Bradbury AW: Geographical inequality in the provision of carotid endarterectomy in Scotland. Br J Surg 1998;85:1075–1079.
6.
Scott PA, Temovsky CJ, Lawrence K, Gudaitis E, Lowell MJ: Analysis of Canadian population with potential access to intravenous thrombolysis for acute ischemic stroke. Stroke 1998;29:2304–2310.
7.
Liu L, Reeder B, Shuaib A, Mazagri R: Validity of stroke diagnosis on hospital discharge records in Saskatchewan, Canada: Implications for stroke surveillance. Cerebrovasc Dis 1999;9:224–230.
8.
Casey MM, Thiede Call K, Klingner JM: Are rural residents less likely to obtain recommended preventative healthcare services? Am J Prev Med 2001;21:182–188.
9.
Campbell NC, Elliott AM, Sharp L, Ritchie LD, Cassidy J, Little J: Rural and urban differences in stage at diagnosis of colorectal and lung cancers. Br J Cancer 2001;84:910–914.
10.
Fortney J, Rost K, Zhang M, Warren J: The impact of geographic accessibility on the intensity and quality of depression treatment. Med Care 1999;37:884–893.
11.
Jones AP, Bentham G, Horwell C: Health service accessibility and deaths from asthma. Int J Epidemiol 1999;28:101–105.
12.
Zhang P, Tao G, Irwin KL: Utilization of preventative medical services in the United States: A comparison between rural and urban populations. J Rural Health 2000;16:349–356.
13.
Yawn BP, Mainous AG, Love MM, Hueston W: Do rural and urban children have comparable asthma care utilization? J Rural Health 2001;17:32–39.
14.
McConnel CE, Zetzman MR: Urban/rural differences in health service utilization by elderly persons in the United States. J Rural Health 1993;9:270–280.
15.
Comer J, Mueller K: Access to health care: Urban-rural comparisons from a Midwestern agricultural state. J Rural Health 1995;11:128–136.
16.
Burgin WS, Staub L, Chan W, Wein TH, Felberg RA, Grotta JC, Demchuk AM, Hickenbottom SL, Morgenstern LB: Acute stroke care in non-urban emergency departments. Neurology 2001;57:2006–2012.
17.
Mayo NE, Danys I, Carlton J, Scott SC: Accuracy of hospital discharge coding for stroke. Can J Cardiol 1993;9(suppl):121D–124D.
18.
Leibson CL, Naessens JM, Brown RD, Whisnant JP: Accuracy of hospital discharge abstracts for identifying stroke. Stroke 1994;25:2348–2355.
19.
Benesch C, Witter DM, Wilder AL, Duncan PW, Samsa GP, Matchar DB: Inaccuracy of the International Classification of Diseases (ICD-9-CM-CM) in identifying the diagnosis of ischemic cerebrovascular disease. Neurology 1997;49:660–664.
20.
Johnsen SP, Overvad K, Sørensen HT, Tjønneland A, Husted SE: Predictive value of stroke and transient ischemic attack discharge diagnoses in the Danish National Registry of Patients. J Clin Epidemiol 2002;55:602–607.
21.
Reker DM, Rosen AK, Hoenig H, Berlowitz DR, Laughlin J, Anderson L, Marshall CR, Rittman M: The hazards of stroke case selection using administrative data. Med Care 2002;40:96–104.
22.
Hill MD, Silver FL, Tu JV, Austin P: Rate of recurrence of stroke after primary intracerebral hemorrhage. Stroke 2000;31:123–127.
23.
Statistics Canada: 1996 Census Dictionary, final ed. Cat No. 92-351-UIE. Ottawa, Statistics Canada, 1999.
24.
Carriere KC, Roos LL: Comparing standardized rates of events. Am J Epidemiol 1994;140:472–482.
25.
Jamrozik K, Broadhurst RJ, Lai N, Hankey GJ, Burvill PW, Anderson CS: Trends in the incidence, severity and short-term outcome of stroke in Perth, Western Australia. Stroke 1999;30:2105–2111.
26.
Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: A prospective study of acute cerebrovascular disease in the community: The Oxfordshire Community Stroke Project 1981–86. 2. Incidence, case fatality rates and overall outcome at one year of cerebral infarction, primary intracerebral and subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 1990;531:16–22.
27.
Sudlow CLM, Warlow CP: Comparing stroke incidence worldwide. Stroke 1996;27:550–558.
28.
Tirschwell DL, Longstreth WT Jr: Validating administrative data in stroke research. Stroke 2002;33:2465–2470.
29.
Chang E, Holroyd BR, Kochanski P, Kelly KD, Shuaib A, Rowe BH: Adherence to practice guidelines for transient ischemic attacks in an emergency department. Can J Neurol Sci 2002;29:358–363.
30.
Barnett S, Roderick P, Martin D, Diamond I: A multilevel analysis of the effects of rurality and social deprivation on premature limiting long term illness. J Epidemiol Community Health 2001;55:44–51.
© 2004 S. Karger AG, Basel
2003
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.