ArticleBMJ open2023
Impact of areal socioeconomic status on prehospital delay of acute ischaemic stroke: retrospective cohort study from a prefecture-wide survey in Japan.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed.
- Time Lost Is Brain Lost: Insights into Acute Ischaemic Stroke Delays in a Tertiary Care Super-speciality Centre in Jharkhand.Annals of neurosciences · 2026Article
- Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.Healthcare (Basel, Switzerland) · 2026Review
- Disparities in Prehospital Stroke Care: Neighbourhood Socioeconomic Status and Delays in Hospital Presentation.Cerebrovascular diseases (Basel, Switzerland) · 2026Article
- Association between rurality and mortality from major diseases in Japan: an ecological study.BMJ open · 2026Article
- Mental Health and Identity Formation Among Primary School Learners: Peer Perceptions of Children Living with Epilepsy Through a Social-Educational Lens.International journal of environmental research and public health · 2025Article
- Impact of Delayed Admission on Treatment Modality and Outcomes of Aneurysmal Subarachnoid Hemorrhage: A Prefecture-Wide, Multicenter Japanese Study.Journal of clinical medicine · 2025Article
- Socioeconomic Status and Stroke: A Review of the Latest Evidence on Inequalities and Their Drivers.Stroke · 2025Review
- Impact of Pre-Hospital and in-Hospital Optimization on the Management of Intravenous Thrombolysis in Hyperacute Ischemic Stroke: A Scoping Review.Risk management and healthcare policy · 2025Review
- Article
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22 authors.
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Abstract
objectivesTo examine whether the Areal Deprivation Index (ADI), an indicator of the socioeconomic status of the community the patient resides in, is associated with delayed arrival at the hospital and poor outcomes in patients with acute ischaemic stroke from a prefecture-wide stroke database in Japan.
designRetrospective study.
settingTwenty-nine acute stroke hospitals in Kochi prefecture, Japan.
participantsNine thousand and six hundred fifty-one patients with acute ischaemic stroke who were urgently hospitalised, identified using the Kochi Acute Stroke Survey of Onset registry. Capital and non-capital areas were analysed separately. PRIMARY AND SECONDARY OUTCOME MEASURES: Prehospital delay defined as hospital arrival ≥4-hour after stroke onset, poor hospital outcomes (in-hospital mortality and discharge to a nursing facility) and the opportunities of intravenous recombinant tissue plasminogen activator (rt-PA) and endovascular reperfusion therapy.
resultsIn the overall cohort, prehospital delay was observed in 6373 (66%) patients. Among individuals residing in non-capital areas, those living in municipalities with higher ADI (more deprived) carried a significantly higher risk of prehospital delay (per one-point increase, OR (95% CI) 1.45 (1.26 to 1.66)) by multivariable logistic regression analysis. In-hospital mortality (1.45 (1.02 to 2.06)), discharge to a nursing facility (1.31 (1.03 to 1.66)), and delayed candidate arrival ≥2-hour of intravenous rt-PA (2.04 (1.30 to 3.26)) and endovascular reperfusion therapy (2.27 (1.06 to 5.00)), were more likely to be observed in the deprived areas with higher ADI. In the capital areas, postal-code-ADI was not associated with prehospital delay (0.97 (0.66 to 1.41)).
conclusionsLiving in socioeconomically disadvantaged municipalities was associated with prehospital delays of acute ischaemic stroke in non-capital areas in Kochi prefecture, Japan. Poorer outcomes of those patients may be caused by delayed treatment of intravenous rt-PA and endovascular reperfusion therapy. Further studies are necessary to determine social risk factors in the capital areas. TRIAL REGISTRATION NUMBER: This article is linked to a clinical trial to UMIN000050189, No.: R000057166 and relates to its Result stage.
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