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. 2018 Sep 28;8(9):e023599.
doi: 10.1136/bmjopen-2018-023599.

What is the evolution of stroke unit's accessibility in metropolitan France from 2009 to 2014? A trend analysis of over 600 000 patients using national hospital databases

Marion Istvan  1 , Camille Lecoffre  2 , Sahar Bayat  1 , Yannick Béjot  3 , Yann Le Strat  2 , Christine De Peretti  4 , Fei Gao  1 , Valérie Olié  2 , Olivier Grimaud  1
Affiliations

What is the evolution of stroke unit's accessibility in metropolitan France from 2009 to 2014? A trend analysis of over 600 000 patients using national hospital databases

Marion Istvan et al. BMJ Open. .

Abstract

Objectives: We aimed to study trends in stroke unit (SU) admission during a period of their deployment in France and to assess whether this led to better and more equitable access to this specialised care.

Design: Analysis of records from the national hospital database.

Setting: All acute care hospitals in metropolitan France for the period 2009-2014.

Participants: Over 600 000 patients admitted in acute care with a main diagnosis of stroke.

Main outcome measures: Admission to a SU.

Results: Between 2009 and 2014, the number of stroke admissions rose from 93 728 to 109 456, and the proportion of SU admission from 23% to 44%. Overall, characteristics associated with higher probability of SU admission were: male gender, younger age, ischaemic stroke type, medium level of comorbidity and larger size of town of residence. Although likelihood of SU admission increased in all patients' categories during the study period, we identified steeper positive temporal trends among older patients, those with more comorbidities and those residing in medium or small towns (all p values <0.001), suggesting a 'catching up' phenomena. Temporal trends of men and women did not differ however.

Conclusions: Admission to SU nearly doubled in France between 2009 and 2014. Faster trends observed for patients with lower admission to SU suggest that equity in access has improved over the period.

Keywords: cerebrovascular disease; epidemiology; health equity; health services Accessibility; stroke; stroke units.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Proportion of admission in stroke unit out of all stroke hospitalisations at the level of French departments (n=96) in years 2009 and 2014.
Figure 2
Figure 2
Number of admissions in stroke unit according to size of town of residence from 2009 to 2014. Missing values were excluded in this figure (0.2%–0.5% of missing values).
Figure 3
Figure 3
Trends in stroke unit admission (reference level: year 2009=1) according to sex, age, size of town of residence and comorbidity.
See this image and copyright information in PMC

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