By CBC News, CBC News | Health
The risk of stroke among pregnant women and those who have just given birth is growing at an alarming rate, say U.S. researchers.
The increase is due to women having increased risk factors for stroke before becoming pregnant, including high blood pressure and obesity, according to a study published Thursday in Stroke: Journal of the American Heart Association.
Researchers found that across the United States, pregnancy-related stroke hospitalizations increased 54 per cent, from 4,085 in 1994-95 to 6,293 in 2006-07.
Those numbers include both pregnant women and women who had given birth in the previous 12 weeks.
Given the increased number of pregnant women with pre-existing risk factors, the researchers said they were expecting to find more were being hospitalized for pregnancy-related strokes.
The magnitude of the increase, however, was a surprise, said Dr. Elena Kuklina, an epidemiologist at the Centers for Disease Control and Prevention.
"When you're relatively healthy, your stroke risk is not that high," Kuklina, lead author of the study, said in a release.
"Now more and more women entering pregnancy already have some type of risk factor for stroke, such as obesity, chronic hypertension, diabetes or congenital heart disease. Since pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk."
The study also found that pregnant and post partum women aged 25 to 34 were hospitalized for stroke more often than those who were younger or older. The researchers did not suggest possible explanations.
Pregnant women are especially difficult to treat because they are usually excluded from clinical trials of medication because of concern drugs can harm the fetus.
As a result, doctors don't have enough information about which medications are best for pregnant women who are at an increased risk for stroke.
By Molly O'Toole, Reuters
Rural Americans are more likely to suffer from chronic health conditions such as diabetes, heart problems and cancer, and face greater difficulty accessing quality healthcare than urban counterparts, according to a report released on Wednesday.
The challenges facing healthcare providers for rural areas could be compounded by recent healthcare legislation, according to the UnitedHealth Center for Health & Reform Modernization.
"This is kind of an opportunity," UnitedHealth chair and report author Simon Stevens told Reuters. "Expanding coverage will mean that more people will have the ability to access care than before, but it's also a wake-up call."
The Center projects that around 8 million more rural residents will join Medicaid, state and government-subsidized insurance plans in the national coverage expansions than would have otherwise -- a net expansion of some 5 million people.
The paper found that there are only 65 primary care physicians per 100,000 rural Americans -- 40 less than the 105 per 100,000 urban and suburban Americans.
Already five million rural residents live in "shortage areas" defined by the federal government as counties with less than 33 primary care physicians per 100,000 residents. The number is continuing to decrease.
Per capita in rural areas there is less than half the number of surgeons and other specialists.
A survey that was part of the study found that among roughly 3,000 patients and primary physicians queried nationwide, those from rural areas were more likely to respond that drug abuse and teen pregnancy are major concerns than were those from urban areas.
Those from rural areas also generally thought the quality of care was lower in their communities than in urban ones.
UnitedHealth confirmed this "equality deficit" is supported by data showing that in 70 percent of markets, rural quality of care was measurably worse than in urban areas.
Though the rural population is aging, placing pressure on public programs like Medicare and Medicaid, UnitedHealth projects rural areas could see higher growth in their non-elderly insured population than urban areas, with increases of over 20 percent in the South and West.
RURAL RESPONSE TO GROWTH
Rural primary care physicians are 15 percent more likely to accept new Medicaid patients as of 2014 than their urban counterparts. Already, urban doctors receive a greater share of their income from public programs than urban doctors.
The report's "roadmap toward a 21st-century health care system," includes a bigger role for nurse practitioners, mobile health clinics, faster uptake of electronic record technology, designing insurance market and public program regulation to meet the needs of rural areas, and engaging more rural consumers in improving their health.
Telemedicine technologies, which use tools such as broadband connectivity to facilitate communication between patients and providers, are crucial to rural areas where distance and low patient and provider density contribute to these health care challenges, according to the report.
UnitedHealth calls for a coordinated effort by patients, providers, private and public sectors to ensure that coverage expansions do not make existing problems worse.
"The next few years will be times of considerable stress on rural health care," the conclusions state, "but also times of great opportunity."