# Association between Acute Care Accessibility and in-Hospital Mortality among Patients with Acute Ischemic Stroke

## TL;DR

This study examines how access to acute care affects in-hospital mortality for patients with acute ischemic stroke in Japan.

## Contribution

The study clarifies the relationship between acute care accessibility and stroke mortality in urban, rural, and depopulated areas.

## Key findings

- Higher acute care density index was linked to increased in-hospital mortality in urban and rural areas.
- Longer home-to-hospital distance in depopulated areas was associated with lower in-hospital mortality.
- Accessibility to acute care had a stronger impact on outcomes than distance in most regions.

## Abstract

Acute ischemic stroke (AIS) can lead to sequelae or death if not treated promptly. Patients residing in areas with limited acute care access may not receive prompt treatment; however, the association between accessibility to acute care and discharge outcomes in patients with AIS remains controversial. This study aimed to clarify the association between acute care density index (ACDI) and home-to-hospital distance and in-hospital mortality in patients with AIS.

Using the Japanese registry of all cardiac and vascular diseases-diagnosis procedure combination database, we examined 525,689 patients (from April 2015 to March 2020). Hospital accessibility was assessed using ACDI and home-to-hospital distance. The patient residences were classified as urban, rural, or depopulated.

In urban areas, ACDI was associated with in-hospital mortality, with adjusted odds ratios for Q2, Q3, and Q4 compared with Q1 of 1.16 (95% confidence interval: 1.02-1.31), 1.23 (1.10-1.39), and 1.35 (1.19-1.53), respectively. Similar trends were observed in rural areas. In depopulated areas, home-to-hospital distance exceeding the median was associated with a reduction in in-hospital mortality, with adjusted odds ratios for Q3 and Q4 compared with Q1 of 0.84 (0.74-0.95) and 0.78 (0.68-0.89), respectively.

A lower ACDI was associated with higher in-hospital mortality in both urban and rural areas, whereas longer home-to-hospital distance was not necessarily associated with higher in-hospital mortality.