Aims Equitable access to post-acute care is critical for older stroke survivors to optimise health outcomes. The study aimed to examine associations between social determinants of health and primary care use in older individuals following stroke.
Methods A retrospective cohort study was conducted using the Registry of Senior Australians. Individuals aged 65-105 years hospitalised with first-ever stroke and accessing long-term care services between 01/01/2008 and 30/06/2018 were included. Intensity models were used to estimate associations between social determinants of health and primary care services within 18 months following hospital discharge, by discharge setting (the community, residential aged care facilities (RACFs) or transition care). Adjusted cumulative risk ratios (aRRs) with 95% confidence intervals (CIs) were obtained via simulation.
Results Among 69,477 stroke survivors (median age 81 years; 56% female; 61% ischaemic stroke), living in non-metropolitan areas was consistently associated with lower access to primary care services, e.g., people living in non-metropolitan areas were less likely to receive management plans [aRRs 0.79 (95% CI 0.75-0.84) for people discharged to RACFs, 0.87 (95% CI 0.84-0.91) for people discharged to the community, and 0.91 (95% CI 0.86-0.96) for people discharged to transition care]. Individuals with a preferred language other than English discharged to the community, and non-homeowners discharged to RACFs, also had a lower rate of primary care attendances.
Conclusions In a national cohort of older stroke survivors, access to primary care services differed by social determinants of health. Targeted interventions are needed to ensure equitable access to post-acute care for this population.