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Access to mechanical thrombectomy and ischemic stroke mortality in Japan : a spatial ecological study

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Title: Access to mechanical thrombectomy and ischemic stroke mortality in Japan : a spatial ecological study
Authors: Ohashi, Kazuki Browse this author →KAKEN DB
Osanai, Toshiya Browse this author →KAKEN DB
Fujiwara, Kensuke Browse this author
Tanikawa, Takumi Browse this author →KAKEN DB
Tani, Yuji Browse this author →KAKEN DB
Takamiya, Soichiro Browse this author
Sato, Hirotaka Browse this author
Morii, Yasuhiro Browse this author →KAKEN DB
Ogasawara, Katsuhiko Browse this author →KAKEN DB
Keywords: mechanical thrombectomy
2-step floating catchment area method
conditional autoregressive model
spatial accessibility
ischemic stroke
Issue Date: 5-Sep-2023
Publisher: Frontiers Media
Journal Title: Frontiers in neurology
Volume: 14
Start Page: 1209446
Publisher DOI: 10.3389/fneur.2023.1209446
PMID: 37731848
Abstract: Background: Advances in stroke treatment have greatly improved outcomes; however, disparities in access to treatment might increase. Achieving equitable access to stroke treatment is a health policy challenge, as rapid treatment is essential for positive outcomes. This ecological cross-sectional study aimed to determine the relationship between the disparities in spatial accessibility to mechanical thrombectomy (SAMT) and stroke mortality rates in Japan, hypothesizing that disparities in SAMT may increase the differences in stroke mortality between regions. Methods: We used the average number of ischemic stroke (IS) deaths between 2020 and 2021 as the response variable; and SAMT, medical resources, and socioeconomic characteristics of each municipality as explanatory variables. A conditional autoregressive model was used to examine the association between the risk of stroke mortality and SAMT. The standardized mortality ratio (SMR) was mapped to understand the nationwide disparities in stroke mortality risk. Results: The median number of IS deaths was 17.5 persons per year in the municipalities (2020 to 2021). The study also found that municipalities with low SAMT were located in the northern part of Japan. The non-spatial regression model results indicated that poor accessibility, a small proportion of bachelor's degrees or higher, and a high proportion of workers in secondary industries were related to high IS mortality. Three models were evaluated using spatial analysis; Model 1 with accessibility indicators alone, Model 2 with medical resources added to Model 1, and Model 3 with socioeconomic characteristics added to Model 2. In Models 1 and 2, the population-weighted spatial accessibility index (PWSAI) showed a significant negative relationship with stroke mortality. However, this was not evident in Model 3. Mapping using Model 3 showed that the high-risk areas were predominantly located in northern Japan, excluding Hokkaido. Conclusion: Access to mechanical thrombectomy was estimated, and regional differences were observed. The relationship between accessibility and IS mortality is unknown; however, regardless of accessibility, municipalities with a high proportion of workers in secondary industries and a small proportion with bachelor's degrees or above are at risk of death from stroke.
Type: article
Appears in Collections:保健科学院・保健科学研究院 (Graduate School of Health Sciences / Faculty of Health Sciences) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 大橋和貴

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