Diagnostic tests and in-hospital treatments of all patients stratified by years and urban/rural
| Tests or treatments | 2005 | 2010 | 2015 | P for interaction | ||||||
| Rural (N=3680) | Urban (N=3348) | Difference % (95% CI) | Rural (N=5128) | Urban (N=4370) | Difference % (95% CI) | Rural (N=5619) | Urban (N=4755) | Difference % (95% CI) | ||
| Diagnostic tests | ||||||||||
| Brain CT/MRI | 2795 (76.9) | 2539 (82.1) | −5.3 (−8.9 to −1.6) | 3964 (79.2) | 3531 (85.6) | −6.4 (−8.3 to −4.5) | 4445 (83.4) | 3947 (85.2) | −1.8 (−3.0 to −0.6) | 0.003 |
| Brain CT | 2674 (70.4) | 2248 (71.3) | −1.0 (−5.0 to 3.1) | 3557 (67.2) | 2926 (68.7) | −1.6 (−3.9 to 0.7) | 3735 (65.4) | 3152 (63.6) | 1.7 (0.2 to 3.3) | 0.038 |
| Brain MRI | 273 (13.4) | 650 (27.8) | −14.4 (−17.7 to −11.1) | 973 (30.5) | 1475 (42.6) | −12.1 (−14.4 to −9.8) | 1656 (39.9) | 2043 (51.1) | −11.2 (−12.9 to −9.6) | 0.010 |
| Cerebrovascular assessment* | 158 (5.3) | 571 (25.6) | −20.3 (−22.8 to −17.8) | 569 (14.8) | 1401 (42.5) | −27.7 (−29.6 to −25.8) | 1326 (30.9) | 2073 (47.6) | −16.7 (−18.3 to −15.2) | <0.001 |
| Cervical vessel assessment† | 91 (5.3) | 314 (16.4) | −11.0 (−13.3 to −8.7) | 535 (19) | 884 (23.1) | −4.1 (−6.1 to −2.2) | 1326 (32.5) | 1466 (32.3) | 0.2 (−1.3 to 1.7) | <0.001 |
| TTE/TEE | 407 (11.5) | 609 (14.7) | −3.2 (−6.1 to −0.3) | 827 (19.5) | 1321 (31.8) | −12.3 (−14.4 to −10.3) | 1581 (35.3) | 1962 (37.8) | −2.4 (−4.0 to −0.9) | <0.001 |
| TTE | 404 (11.4) | 602 (14.5) | −3.1 (−6.0 to −0.2) | 804 (19.1) | 1312 (31.6) | −12.5 (−14.6 to −10.5) | 1544 (34.7) | 1942 (37.3) | −2.6 (−4.2 to −1.1) | <0.001 |
| TEE | 9 (0.3) | 14 (0.3) | 0.0 (−0.4 to 0.5) | 99 (1.4) | 64 (2.2) | −0.7 (−1.3 to −0.1) | 215 (6.8) | 129 (2.4) | 4.4 (3.7 to 5.1) | <0.001 |
| Holter | 181 (7.2) | 174 (5.5) | 1.7 (−0.5 to 4.0) | 477 (8.9) | 396 (9.9) | −1.0 (−2.4 to 0.4) | 557 (11.2) | 496 (11.8) | −0.6 (−1.6 to 0.5) | 0.32 |
| 24-hour blood pressure monitor | 116 (2.5) | 83 (3.5) | −1.0 (−2.4 to 0.5) | 234 (2.9) | 262 (5.4) | −2.5 (−3.4 to −1.6) | 374 (8.2) | 369 (8.8) | −0.6 (−1.5 to 0.3) | <0.001 |
| Composite score of tests‡ | 0.18±0.06 | 0.24±014 | −0.06 (−0.07 to −0.05) | 0.23±0.13 | 0.33±0.22 | −0.10 (−0.11 to −0.10) | 0.32±24 | 0.37±33 | −0.04 (−0.05 to −0.03) | <0.001 |
| Homocysteine | 12 (0.9) | 24 (0.5) | 0.4 (−0.4 to 1.1) | 209 (11.3) | 646 (20) | −8.7 (−10.3 to −7.1) | 1715 (41.2) | 2011 (43.1) | −1.9 (−3.5 to −0.3) | <0.001 |
| Glycated haemoglobin | 43 (2.1) | 186 (4.7) | −2.6 (−4.0 to −1.2) | 429 (12.9) | 823 (23.3) | −10.4 (−12.1 to −8.6) | 1375 (30.8) | 1775 (36.5) | −5.7 (−7.2 to −4.2) | <0.001 |
| rt-PA use when arrived within 1 day after onset§ | 18 (0.3) | 4 (0.1) | 0.2 (−0.2 to 0.6) | 1 (0.0) | 2 (0.0) | −0.0 (−0.1 to 0.0) | 12 (0.2) | 27 (0.8) | −0.6 (−0.8 to −0.4) | |
| Secondary prevention treatments | ||||||||||
| Antiplatelets | 2462 (72.1) | 1889 (55.6) | 16.6 (12.6 to 20.5) | 3548 (75.2) | 3130 (72.7) | 2.4 (0.4 to 4.5) | 4130 (75.1) | 3764 (77.8) | −2.7 (−4.1 to −1.4) | <0.001 |
| Aspirin | 2384 (70.3) | 1796 (51.8) | 18.5 (14.5 to 22.5) | 3442 (70.4) | 2872 (63) | 7.4 (5.2 to 9.6) | 3750 (67.8) | 3236 (64.9) | 2.9 (1.4 to 4.4) | <0.001 |
| Clopidogrel | 12 (0.6) | 55 (2.7) | −2.1 (−3.0 to −1.2) | 218 (9) | 454 (14.9) | −5.9 (−7.4 to −4.4) | 1012 (21.9) | 1336 (32.2) | −10.3 (−11.7 to −8.9) | 0.50 |
| Aspirin plus clopidogrel | 11 (0.6) | 29 (1.3) | −0.7 (−1.4 to 0.1) | 127 (4.5) | 205 (5.5) | −1.1 (−2.1 to −0.1) | 649 (14.7) | 812 (19.3) | −4.6 (−5.7 to −3.4) | 0.70 |
| Anticoagulant for AF | 3 (2.1) | 18 (13) | −10.9 (−18.1 to −3.8) | 12 (5.4) | 19 (9.0) | −3.6 (−8.8 to 1.6) | 18 (6.7) | 41 (15.0) | −8.2 (−12.3 to -4.1) | 0.45 |
| Antihypertensive drugs | 1891 (70.1) | 1726 (72.3) | −2.2 (−6.8 to 2.3) | 2650 (69.1) | 2342 (66.2) | 2.8 (0.3 to 5.4) | 2616 (62.5) | 2378 (64.5) | −2.0 (−3.8 to −0.2) | 0.004 |
| Hypoglycaemic drugs | 395 (68.2) | 567 (66.1) | 2.1 (−7.5 to 11.6) | 653 (74.9) | 794 (73.7) | 1.2 (−3.2 to 5.6) | 776 (71.0) | 938 (68.6) | 2.4 (−0.6 to 5.4) | 0.14 |
| Statins | 412 (11.9) | 432 (14.6) | −2.7 (−5.5 to 0.2) | 1848 (45.6) | 1668 (40.3) | 5.2 (2.8 to 7.6) | 3404 (68.9) | 3161 (70.7) | −1.8 (−3.3 to −0.3) | 0.003 |
| Composite score of secondary prevention treatments¶ | 0.50±12 | 0.45±0.23 | 0.05 (0.03 to 0.06) | 0.62±0.23 | 0.59±0.36 | 0.03 (0.02 to 0.04) | 0.68±0.36 | 0.70±0.49 | −0.02 (−0.03 to −0.00) | 0.020 |
| Traditional Chinese medicine | 2954 (79.4) | 2488 (71.3) | 8.2 (4.6 to 11.8) | 4383 (85.3) | 3788 (85.4) | −0.1 (−1.8 to 1.6) | 4799 (84.0) | 3808 (82.1) | 1.9 (0.7 to 3.1) | 0.022 |
| Intervention | ||||||||||
| Dysphagia screening | 48 (0.9) | 132 (4.2) | −3.3 (−4.4 to −2.2) | 218 (7.3) | 254 (6.5) | 0.8 (−0.4 to 2.1) | 391 (14.5) | 292 (7.1) | 7.4 (6.4 to 8.4) | <0.001 |
| Rehabilitation assessment | 153 (5.7) | 211 (8.3) | −2.5 (−4.7 to −0.4) | 336 (6.9) | 320 (8.2) | −1.2 (−2.5 to 0.1) | 358 (6.9) | 489 (9.7) | −2.8 (−3.7 to −1.9) | 0.41 |
Data are presented by weighted mean along with SD (mean±SD) or median along with IQR (median (IQR)) for continuous variables and unweighted frequency along with weighted % (95% CI) for categorical variables. A total of 1374 patients (466, 488 and 420 patients in 2005, 2010, and 2015, respectively) with length of stay ≤1 day were excluded from this analysis first because of inadequate time to be given relative tests, treatments or interventions.
*Includes brain CT angiography, magnetic resonance angiography, transcranial Doppler and/or digital subtraction angiography.
†Included cervical CT angiography, magnetic resonance angiography, carotid ultrasound and/or digital subtraction angiography.
‡Composite score of tests was derived from brain CT/MRI, cerebrovascular assessment, cervical vessel assessment, TTE/TEE, Holter and 24-hour blood pressure monitor.
§For most patients, the onset time and admission time to hospitals were not documented, and we could only calculate the time intervals by day.
¶Composite score of secondary prevention treatments was derived from in-hospital antiplatelets, anticoagulant for AF, antihypertensive drugs, hypoglycaemic drugs and statins therapy.
AF, atrial fibrillation; rt-PA, recombinant tissue plasminogen activator; TEE, transoesophageal echocardiography; TTE, transthoracic echocardiography.