The effect of regional disparities in access to rehabilitation services on mortality among stroke patients

This study aimed to analyze physical therapy (PT) and occupational therapy (OT) claims data to determine whether access barriers to rehabilitation services due to regional factors affect PT and OT accessibility. Furthermore, we investigated the mortality rate of stroke patients by region in South Korea using the National Health Insurance Service-National Sample Cohort database. This is a register-based, retrospective cohort study. Using data from the National Health Insurance Service database, we included patients who were newly diagnosed with stroke between 2005 and 2017. Of the 19,067 patients diagnosed with stroke, 2263 who died within 6 months were excluded. The final sample included 16,804 patients (51.3% men and 48.7% women). Residential regions were categorized into Capital, Capital area, Metropolitan, and Rural area. After adjusting for covariates, a logistic regression model was used to analyze the accessibility of rehabilitation services by residential region. The Kaplan–Meier method was employed to compare the survival rates of rehabilitation patients across different residential regions. A Cox proportional hazards model was used to estimate the independent contribution of each factor to mortality risk (hazard ratios [HRs] and 95% confidence interval [CIs]). Significant differences in mortality were observed according to sociodemographic factors and Charlson Comorbidity Index scores. Accessibility in Capital area and Metropolitan cities was comparable to the Capital. However, patients living in a rural area had significantly lower access to rehabilitation compared to those in the Capital (PT: OR = 0.889, 95% CIs: 0.809–0.987, P  = .029; OT: OR = 0.802, 95% CIs: 0.726–0.886, P  = .001). Notably, among those receiving inpatient rehabilitation, rural area residency was associated with a higher risk of death compared to the Capital (HRs = 1.288; 95% CIs, 1.015–1.635; P  = .037). In contrast, no significant disparity was found in the outpatient group (HRs = 1.011; 95% CIs, 0.917–1.115; P  = .820). Stroke patients living in rural area were less likely to receive rehabilitation services than those in the capital. This regional disparity in access, particularly in inpatient rehabilitation, is associated with an increased risk of long-term mortality after stroke. These findings suggest that improving inpatient rehabilitation infrastructure in rural area is critical to reducing survival gaps.