Spatial Distribution And Direction Of 30-day Readmission Of Stroke Patients In Hunan Province In 2018

Objective: To explore the spatial distribution and spatial clustering of 30-day readmission of stroke patients in each county of Hunan Province.To explore the spatial heterogeneity of main relevant factors of 30-day readmission of stroke patients in Hunan province.To explore the direction characteristics of 30-day readmission of stroke patients in Hunan province,and provide reference for improving the regionalized prevention and control policies and measures for stroke readmission.Methods: Stroke patients in Hunan province who were readmitted within 30 days of discharge in 2018 were used as the study population,with county as the spatial analysis unit.SPSS 26.0 was used for descriptive analysis of general conditions.Arc GIS 10.8 was used to map the spatial distribution of 30-day readmission rate of stroke patients,and further spatial autocorrelation analysis and spatial regression analysis were used to explore the spatial aggregation of 30-day readmission rate of stroke and the spatial heterogeneity of the readmission rate with the main influencing factors.The 30-day readmission flow network of stroke patients was further constructed,and scatter plots of the number of 30-day readmission rate,the number of transfers and the number of transfers in each county of Hunan province were drawn respectively to describe the distribution of the hospitalizations before and after.Results: In 2018,a total of 6953 stroke patients were hospitalized again due to stroke within 30 days after discharge in Hunan province,with a 30-day readmission rate of 4.09% in the province.The 30-day readmission rate of stroke in Hunan province ranged from 0.00% to11.08%,showing a zigzagged distribution,with higher rates in the west,northeast and southeast,and lower rates in the central region.There were13 "hot spots" in the northeast and western regions for 30-day readmission rate(P<0.05).Spatial regression showed that the proportion of patients with complications(b=0.612,P=0.008),the number of hospitals per 10 000population(b=-0.161,P=0.004)and the number of primary medical institutions per 10 000 population(b=0.050,P=0.004)were the main influencing factors for stroke readmission.Geographically weighted regression showed that the proportion of complications increased from east to west,with regression coefficients ranging from 0.19 to 3.53.Hospital number per million population regression coefficient in the range of0.62～0.83,showed a trend of increase from west to east,and the west and southwest of regression coefficient is negative,the rest is positive.The regression coefficient of the number of primary medical institutions per10,000 population ranged from-0.01 to 0.08,showing a trend of gradual increase in the northeast,south and west regions,and the regression coefficient was negative in the northeast region.Changsha-Zhuzhou-Xiangtan urban cluster was located in the middle of the flow direction network,and Southern Hunan urban group was concentrated in 2～3 counties.Dongting lake urban group and Western Hunan urban group are scattered around.The districts and counties with high 30-day readmission rate and high number of people transferring out were mainly distributed in Changsha-Zhuzhou-Xiangtan urban group,Southern Hunan urban group and Western Hunan urban group.The districts and counties with high 30-day readmission rate and low number of people transferring out were mainly distributed in Changsha-Zhuzhou-Xiangtan urban group and Western Hunan urban group.Changsha-ZhuzhouXiangtan urban group and Western Hunan urban group mainly distributed in the districts and counties with high 30-day readmission rate and high transfer number.Districts with a high 30-day readmission rate and a low number of transfers were mainly distributed in Southern Hunan urban group and Western Hunan urban group.Conclusions:(1)The 30-day readmission rate in Hunan province was4.09%,ranging from 0.00% to 11.08%.(2)The 30-day readmission rate in Hunan province showed a zigzagged distribution,with higher rates in the west,northeast and southeast,and lower rates in the central region.Hot spots were mainly distributed in Changsha-Zhuzhou-Xiangtan urban group and Western Hunan urban group.(3)The geographically weighted regression revealed that proportion of patients with complications,number of hospitals per 10,000 population and number of primary medical and health care institution per 10,000 population were the main related factors of stroke readmission,and there were differences both in the direction and degree of their effect on readmission in different regions.Local measures should be adapted to local conditions to take targeted prevention and treatment measures to effectively control the 30-day readmission rate of stroke.(4)Changsha-Zhuzhou-Xiangtan urban cluster was located in the middle of the flow direction network,and Southern Hunan urban group was concentrated in 2～3 counties.Dongting lake urban group and Western Hunan urban group are scattered around.30 days readmission rate higher areas should adjust measures to local conditions,formulate relevant prevention and control measures in order to reduce the rate of readmission.