Brief Reports Influence of Socioeconomic Status on Distance Traveled and Care After Stroke

Background and Purpose—Vital to maintaining an efficient delivery of services is an understanding of patient travel patterns during an acute ischemic stroke. Socioeconomic status may influence access to stroke care, including transportation and admission to different facility types. Methods—We analyzed all acute ischemic stroke admissions between 2003 and 2007 through the Discharge Abstract Database, a national database containing patient-level sociodemographic, diagnostic, procedural, and administrative information across Canada. Socioeconomic status was defined in neighborhood quintiles according to Statistics Canada. Distances between patients and facilities were derived from postal codes. A principal diagnosis of ischemic stroke was identified using the International Classification of Diseases (versions 9 and 10). Analysis of variance and regression analyses were performed with adjustment for demographic characteristics. Results—Admitted to acute care institutions were 243 410 patients with ischemic stroke. Mean patient age was 72.8 and 49.5% were male; 44.2% traveled beyond their closest center, amounting to an average 7.2 km additional distance traveled. Socioeconomic status quintile had minimal effect on travel patterns, with the lowest socioeconomic status accessing the closest center most frequently and ambulance use increased travel beyond the closest center. Conclusions—Patients tend to choose care facilities based on hospital expertise; investment promoting improved regional facilities may be of greatest benefit to patients. Socioeconomic status has little bearing on travel patterns associated with stroke in Canada. These findings may assist in allocating funding to centers and improving patient care. I n the past 2 decades, there has been an unprecedented increase in population age, bringing an increased burden of stroke and the need for efficient high-quality health care delivery. 1,2 Escalating levels of organized stroke care have been shown to significantly improve patient outcome. 3,4 Unfortunately, these interventions are often limited to larger and more comprehensive stroke centers. 5,6 Thus, it is important to identify whether patients' selection of stroke care facilities is based on proximity or level of expertise and resource, and how this travel is affected by socioeconomic status (SES) and ambulance use. A better understanding of patient flow would help determine whether care required matches care provided and how to optimally allocate public resource. We examined the association between SES and travel patterns during a stroke. Secondarily, we examined the association between patient demographics, ambulance use, hospital expertise, and community type on travel patterns. We hypothesized that patients with low SES receive care at the nearest and less specialized hospital. We conducted a retrospective …