Table 3. Changes in Rural-Urban Disparities in the Use of Specialized Stroke Centers, Neurologists, and Stroke Procedures, 2008 vs 2017a.
| Characteristic | Admissions, No. (%) | Adjusted change in disparity from 2008 to 2017, estimate (95% CI) | |||||
|---|---|---|---|---|---|---|---|
| 2008 | 2017 | ||||||
| Rural | Urban | Unadjusted disparity | Rural | Urban | Unadjusted disparity | ||
| Stroke center use during admission | 24 681 (25.2) | 161 217 (60.6) | −35.4 (−35.7 to −35.0) | 33 220 (38.3) | 157 161 (64.9) | −26.6 (−26.9 to −26.2) | −8.7 (−10.8 to −6.6) |
| Presenting hospital | 21 020 (21.4) | 159 096 (59.8) | −38.3 (−38.7 to −38.0) | 25 976 (29.9) | 152 539 (63.0) | −33.0 (−33.4 to −32.6) | −5.2 (−7.4 to −3.1) |
| Discharging hospital | 24 616 (25.1) | 160 942 (60.5) | −35.3 (−35.7 to −35.0) | 33 113 (38.2) | 156 645 (64.6) | −26.5 (−26.8 to −26.1) | −8.8 (−10.9 to −6.7) |
| Neurologist evaluation during admission | 6489 (33.2) | 34 556 (63.9) | −30.7 (−31.5 to −29.9) | 7858 (45.2) | 33 798 (69.4) | −24.2 (−25.0 to −23.4) | −6.3 (−8.4 to −4.2) |
| On first day of admission | 3035 (15.5) | 16 206 (30.0) | −14.4 (−15.1 to −13.7) | 3529 (20.3) | 14 724 (30.2) | −9.9 (−10.7 to −9.2) | −4.4 (−5.9 to −2.9) |
| Treated with alteplase or thrombectomy | 1072 (1.1) | 5908 (2.2) | −1.1 (−1.2 to −1.0) | 6080 (7.0) | 21 659 (8.9) | −1.9 (−2.1 to −1.7) | 0.8 (0.5-1.2) |
| Alteplase use | 1014 (1.0) | 5718 (2.1) | −1.1 (−1.2 to −1.0) | 5466 (6.3) | 19 041 (7.9) | −1.6 (−1.8 to −1.4) | 0.5 (0.1-0.8) |
| Thrombectomy use | 115 (0.1) | 487 (0.2) | −0.1 (−0.1 to −0.0) | 1192 (1.4) | 5015 (2.1) | −0.7 (−0.8 to −0.6) | 0.6 (0.5-0.8) |
Unadjusted disparities are the rural mean in each year less the urban mean. The adjusted disparities shown in the final column are the estimated differences between rural and urban changes in each outcome between 2008 and 2017 after adjusting for patient age, sex, race/ethnicity, Medicaid enrollment in prior 12 months, original Medicare entitlement reason (whether for age, disability, or end-stage kidney disease), and 27 indicators for chronic conditions prior to admission. Standard errors were clustered by beneficiary state and 95% CIs are presented along with our estimates. Negative adjusted changes indicate disparities that have become smaller during the study period. Positive adjusted changes indicate disparities that have become larger during the study period.