Scholarlink

Background <p>Globally, stroke is a leading cause of mortality and disability, affecting approximately 15&#xa0;million people annually. This study aimed to analyze hospitalizations, deaths, and thrombolysis for ischemic stroke in Southern Brazil, evaluate access within the 4.5-hour window at Neurological Reference Centers (NRCs), and explored potential coverage expansions.</p> Methods <p>An ecological study was conducted using hospitalization data, intravenous thrombolysis administration, and ischemic stroke related deaths among individuals aged 40–79 years treated in the Brazilian Unified Health System and residing in the Southern region between 2015 and 2024. Space Cube Time analyses, the Enhanced Two-Step Floating Catchment Area method, and spatial coverage simulations for potential new centers using the Maximal Covering Location Problem model were applied.</p> Results <p>The Space-Time Cube analysis revealed no significant temporal trends in hospitalization and mortality rates due to ischemic stroke (Mann–Kendall test, <i>p</i> = 1.000), while a statistically significant increasing trend was observed in the use of thrombolytic therapy (trend = 3.0411; <i>p</i> = 0.0024), despite only 5% of hospitalized patients receiving the treatment. Furthermore, greater distance and travel time to NRCs were associated with higher mortality rates: municipalities located within two hours of an NRC showed a lower mean mortality rate (14.88 per 100,000 inhabitants) compared with those beyond this range (17.35 per 100,000 inhabitants), representing a difference of 2.47 deaths per 100,000 inhabitants (<i>p</i> &lt; 0.005). Given this disparity, the simulation of adding 10 new NRCs, in addition to the 49 existing ones, estimated the prevention of 21.45 deaths per year, totaling approximately 214 deaths avoided over a decade.</p> Conclusion <p>The combined findings of low intravenous thrombolysis utilization, limited access to NRCs, and higher mortality rates in inland municipalities underscore the need to expand specialized stroke care. Moreover, the simulation results indicate that broadening the coverage of NRCs could inform health policy planning aimed at reducing inequities in stroke care and lowering mortality and morbidity.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Spatiotemporal analysis of hospitalizations, mortality and access to intravenous thrombolysis for ischemic stroke in Southern Brazil

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年3月23日

查看全文
  • Samile Bonfim,
  • Miyoko Massago,
  • Vinicius Lopes Giacomin,
  • Matheus Henrique Arruda Beltrame,
  • Amanda de Carvalho Dutra,
  • William Filipin Costa,
  • Luiz Carlos Thomé Filho,
  • Luciano de Andrade

摘要

Background

Globally, stroke is a leading cause of mortality and disability, affecting approximately 15 million people annually. This study aimed to analyze hospitalizations, deaths, and thrombolysis for ischemic stroke in Southern Brazil, evaluate access within the 4.5-hour window at Neurological Reference Centers (NRCs), and explored potential coverage expansions.

Methods

An ecological study was conducted using hospitalization data, intravenous thrombolysis administration, and ischemic stroke related deaths among individuals aged 40–79 years treated in the Brazilian Unified Health System and residing in the Southern region between 2015 and 2024. Space Cube Time analyses, the Enhanced Two-Step Floating Catchment Area method, and spatial coverage simulations for potential new centers using the Maximal Covering Location Problem model were applied.

Results

The Space-Time Cube analysis revealed no significant temporal trends in hospitalization and mortality rates due to ischemic stroke (Mann–Kendall test, p = 1.000), while a statistically significant increasing trend was observed in the use of thrombolytic therapy (trend = 3.0411; p = 0.0024), despite only 5% of hospitalized patients receiving the treatment. Furthermore, greater distance and travel time to NRCs were associated with higher mortality rates: municipalities located within two hours of an NRC showed a lower mean mortality rate (14.88 per 100,000 inhabitants) compared with those beyond this range (17.35 per 100,000 inhabitants), representing a difference of 2.47 deaths per 100,000 inhabitants (p < 0.005). Given this disparity, the simulation of adding 10 new NRCs, in addition to the 49 existing ones, estimated the prevention of 21.45 deaths per year, totaling approximately 214 deaths avoided over a decade.

Conclusion

The combined findings of low intravenous thrombolysis utilization, limited access to NRCs, and higher mortality rates in inland municipalities underscore the need to expand specialized stroke care. Moreover, the simulation results indicate that broadening the coverage of NRCs could inform health policy planning aimed at reducing inequities in stroke care and lowering mortality and morbidity.