University Of Tasmania

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Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review

journal contribution
posted on 2023-05-20, 01:10 authored by Mitchell DwyerMitchell Dwyer, Sabah RehmanSabah Rehman, Ottavi, T, Stankovich, J, Seana GallSeana Gall, Gregory PetersonGregory Peterson, Karen FordKaren Ford, Leigh Kinsman

Objective: To describe literature pertaining to urban-rural differences in both the quality of care and outcomes of acute stroke patients.

Methods: We systematically searched CINAHL, PubMed, ProQuest Dissertations & Theses, and Scopus for published and unpublished literature until 9th December 2017. Studies were included if they compared the acute care provided to, or outcomes of, patients hospitalised for stroke in urban versus rural settings. Abstract, full-text review, and data extraction were conducted in duplicate. Findings are presented in the form of narrative syntheses.

Results: A total of 28 studies were included in the review (16 on care, 12 on outcomes). With few exceptions, studies addressing the provision of care suggested that rural patients have less access to most aspects of acute stroke care. Studies reporting urban-rural differences in patient outcomes were inconsistent in their findings, however, few of these studies were primarily focused on the issue of urban-rural disparities. Overall, study findings did not appear to differ in line with study quality ratings, stroke subtypes included, or how inter-facility patient transfers were accounted for.

Conclusions: There is convincing, albeit not unanimous, evidence to suggest that stroke patients in rural areas receive less acute care than their urban counterparts. Despite this, the available data and methodology have largely not been used to study urban-rural differences in patient outcomes.


Publication title

Journal of The Neurological Sciences








Tasmanian School of Medicine


Elsevier Science Bv

Place of publication

Po Box 211, Amsterdam, Netherlands, 1000 Ae

Rights statement

Copyright 2018 Elsevier B.V.

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified; Rural and remote area health