spAtiAl distribution of in-hospitAl mortAlity following stroke in frAnce, 2008-2011

Abstract

background: In the context of implementing the National Stroke Plan in France, a spatial approach was used to measure inequalities in this disease. Using the national PMSI-MCO database, we analyzed the in-hospital prevalence of stroke and established a map of in-hospital mortality rates with regard to the socio-demographic structure of the country. methods: The principal characteristics of patients were studied. A map ofstandardized mortality rates at the level of PMSI geographic codes was established.An exploratory analysis using INSEE socio-economic data and mortality rates was also carried out to identify different area profiles. results: Between 2008 and 2011, the number of stroke patients increased by 3.85 %, notably for ischemic stroke in the 36–55 years age group. Over the same period, in-hospital mortality fell, and the map of standardized rates illustrated the diagonal of high mortality extending from the north-east to the south-west of the country. The most severely affected areas were also those with the least favorable socio-professional indicators. conclusions: The PMSI-MCO database can be used for the spatial description of the performance of certain healthcare indicators, such as in-hospital mortality. Our study showed the interplay between social and demographic factors and stroke-related in-hospital mortality. The study raises questions about access to stroke units in isolated areas. Telemedicine appears to be the solution favored by decision makers. The aging of the population managed for stroke must not mask the growing incidence in younger people, which raises questions about the development of classical (smoking, hypertension) or new (drug abuse) risk factors.