Stroke is the potentially devastating result of a sudden interruption of blood flow to the brain. It is a leading cause of death and disability world wide and incidence is expected to increase due to an aging population and increased prevalence in risk factors.
Epidemiological research can enhance our understanding of stroke as a health problem in the population with respect to the extent of disease incidence and prevalence, the efficacy of health care delivery for stroke prevention and acute care, and to inform public health policy and planning.
Geographic Information Systems (GIS) technology and spatial methods provide the means to store and retrieve spatially indexed health data, display the spatial information in maps, and conduct analyses examining health service delivery and utilization.
The overall objective of this research is to enrich our current understanding of stroke as a health problem in the province of Alberta, Canada. This thesis is comprised of three studies. The first study utilized GIS-based methods and administrative datasets to identify and locate significant clusters of high and low rates of the major stroke types and in-hospital mortality. Important questions were raised regarding why regional differences exist and how disparities might be mitigated.
The second study expanded upon the cluster analysis with an examination of associations between selected predictors and stroke and mortality hot and cold spots, mortality at the individual level, and recurrent stroke, using multivariable logistic regression. Distance from specialized stroke care was a significant predictor of index and recurrent stroke and mortality. EMS transport and Comprehensive Stroke Centre care significantly lowered the odds of stroke mortality.
The third study employed spatial methods to evaluate the concordance of GIS predicted versus actual EMS ground transport times and to estimate the proportion of the Alberta population with potential and realized access to stroke care within critical time windows. GIS methods predicted ground transport time with reasonable accuracy and there was expanded access to stroke care over a 5-year time span.
This research highlights the benefits of incorporating spatial methods and GIS in epidemiological research to elucidate how and to what extent place matters to health.