Stroke patients living in rural areas of South Korea were less likely to receive physical and occupational therapy than those in the Capital, and among inpatient rehabilitation recipients, rural residence was associated with a higher risk of long-term mortality, suggesting that improving inpatient rehabilitation infrastructure in rural areas is critical to reducing survival gaps.
Rural residents with stroke had significantly lower access to both physical therapy and occupational therapy than residents of the Capital.
Rehabilitation accessibility in the Capital area and Metropolitan cities was comparable to that in the Capital.
Among stroke patients receiving inpatient rehabilitation, rural residence was associated with a higher risk of death than Capital residence.
No significant regional mortality disparity was found among patients receiving outpatient rehabilitation.
Mortality differed significantly according to sociodemographic factors and Charlson Comorbidity Index scores.
The study cohort comprised 16,804 newly diagnosed stroke patients from the Korean National Health Insurance Service-National Sample Cohort, 2005-2017.
The authors conclude that regional disparity in access, particularly to inpatient rehabilitation, is associated with increased long-term post-stroke mortality.
This study used South Korean national health insurance data on 16,804 people who had a new stroke between 2005 and 2017. It looked at whether where people live affects their access to physical and occupational therapy, and whether that relates to how long they survive. People living in rural areas were less likely to receive these therapies than people living in the Capital, while those in the Capital area and metropolitan cities had access similar to the Capital. Among patients who received inpatient (hospital-based) rehabilitation, those living in rural areas had a higher risk of death over the long term than those in the Capital, about 29% higher after accounting for other factors. No such difference in death risk was seen among patients receiving outpatient rehabilitation. Age, other sociodemographic factors, and the burden of other illnesses were also linked to mortality. This research suggests that gaps in rehabilitation access across regions, especially inpatient rehabilitation in rural areas, may contribute to differences in survival after stroke. Because this is an observational study, it shows associations rather than proving cause. The authors suggest that strengthening inpatient rehabilitation services in rural areas could help narrow survival gaps.
Yoo D, Baek C, Choi J. (2026). The effect of regional disparities in access to rehabilitation services on mortality among stroke patients: A Korean nationwide population-based retrospective cohort study.. Medicine. https://doi.org/10.1097/MD.0000000000051192