How far is too far? Geographic distance and outcomes in acute ischemic stroke in a middle-income country.
Frontiers in neurology · 2026-01-01 · Registry study
Abstract
INTRODUCTION: Geographic distance to specialized centers is a critical barrier to stroke care, influencing access, treatment delays, and early clinical outcomes. OBJECTIVE: To evaluate the association between geographic distance to a Comprehensive Stroke Center (CSC) and clinical outcomes in patients with acute ischemic stroke (AIS) in a middle-income country. METHODS: A Retrospective cohort study using a prospective registry of adult AIS patients in Colombia. Exposure was road distance (km) from the municipality of origin to the CSC. Outcomes included in-hospital case-fatality and functional status at discharge (modified Rankin Scale [mRS]). Multivariable logistic and ordinal regressions adjusted for age, neurological severity (NIHSS), and mode of arrival. RESULTS: Of 529 patients, 40.64% lived ≤12.8 km and 24.76% lived ≥118 km from the CSC. Increased distance was associated with higher interfacility referrals (85.50% vs. 51.16%, p < 0.001). Intrahospital quality metrics and in-hospital case-fatality (p = 0.371) were comparable across distance groups. In multivariable analysis, in-hospital case-fatality was driven by older age (OR 1.03; 95% CI 1.00-1.06) and higher NIHSS (OR 1.15; 95% CI 1.11-1.197), while mode of arrival was also independently associated with mortality and sex was not independently associated. Geographic distance was independently associated with worse functional outcomes at discharge (OR 1.25; 95% CI: 1.09-1.44 per ln[km] increase), alongside age (OR 1.03; 95% CI: 1.02-1.04). CONCLUSION: Greater geographic distance was independently associated with worse functional outcomes at discharge. However, distance did not adversely affect in-hospital quality of care or in-hospital case-fatality. These findings highlight the need to strengthen prehospital systems and post-acute rehabilitation to reduce geography-related disparities in functional recovery.