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Int J Stroke. 2013 Apr;8(3):164-71. doi: 10.1111/j.1747-4949.2011.00717.x. Epub 2012 Feb 2.

Hospital management and outcomes of stroke in Indigenous Australians: evidence from the 2009 Acute Care National Stroke Audit.

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1
Florey Neuroscience Institutes, Heidelberg, Vic, Australia. monique.kilkenny@monash.edu

Abstract

BACKGROUND:

Indigenous Australians have greater stroke mortality rates than non-Indigenous people (97% Indigenous Australians are aged <65 years). Quality of care in hospital is an important factor for avoiding death and disability. No national review of acute stroke care for Indigenous Australians is available.

AIMS:

We aimed to compare adherence with clinical processes and outcomes among Indigenous and non-Indigenous patients with acute stroke admitted to hospital.

METHODS:

Hospitals participating in the National Stroke Audit of acute services in 2009 that provided data for at least one Indigenous patient were included (n = 33, 37%). Differences in death/dependency (modified Rankin Score 3-6) at discharge were determined using two-level multivariate analysis adjusting for hospital site and patient variables. A matched subgroup analysis in those aged 18 to 64 years was also undertaken.

RESULTS:

Among 1162 eligible patients (60% male; 18-64 years n = 305), 7% were Indigenous (18-64 years: 18%). Indigenous patients had a greater prevalence of stroke risk factors, e.g. diabetes, more had intracerebral hemorrhages (25% vs. 16% non-Indigenous, P = 0.05), and were less likely be treated in a stroke unit and receive timely allied health assessments than non-Indigenous patients. Indigenous patients aged 18-64 years had a threefold odds of dying or being dependent at discharge (Adjusted odds ratio = 3.09, 95% confidence interval = 1.07-8.95).

CONCLUSIONS:

Australian Indigenous patients with stroke received a reduced quality of care in hospitals and experienced worse outcomes than non-Indigenous patients. Indigenous patients require the provision of evidence-based care to increase their opportunities for optimal health outcomes following stroke. Further research to explain the differences is needed.

[Indexed for MEDLINE]

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