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Health care providers’ effect on long-term mortality after the first-ever stroke: application of shared frailty survival models

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Abstract

Background

Stroke is a global public health challenge. Frailty models can detect and consider the effects of the unknown factors influencing survival along with other known factors. This study aims to evaluate health care providers’ effect, along with the demographic and clinical factors, on the stroke patients’ survival by using the shared frailty survival models.

Methods

In the 2-year follow-up, a total of 1036 patients with first-ever stroke were recruited from 2013 up to 2015 with census sampling method from two hospitals of Iran, as the health care providers. For model selection, we fitted parametric and semiparametric survival models with parametric shared frailty and used the goodness of fit criteria to compare the models.

Result

The median follow-up was 730 days. The rate of mortality was 38% during the follow-up period. The Weibull model with gamma frailty had a better fit than the other survival models. The significant variables from the Weibull model were NIHSS score as the stroke severity (score < 5: reference category; scores 5–19: HR = 2.99, p value < 0.001; score ≥ 20: HR = 5.66, p value < 0.001) and age (HR = 1.03, p value < 0.001). Even with the incorporation of the demographic and clinical factors in the survival model, the effect of health care providers as the shared frailty effect was significant (p < 0.001).

Conclusions

Despite considering the known demographic and clinical prognostic factors, health care providers’ effect on the patients’ survival after stroke was still significant. This may be due to the existing difference between two hospitals in facilities, management, coordination, and efficiency of treatment.

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Data availability

The data of this study were collected from two hospitals, under the supervision of Tabriz University of Medical Sciences. The dataset analyses during the current study are available from the corresponding author on reasonable request.

Code availability

Statistical analysis was done by Stata version 16 (College Station, TX: Stata Corp LLC; 2019). The ethics code of the study is IR.TBZMED.REC.1398.1203.

Abbreviations

NIHSS:

Modified National Institutes of Health Stroke Scale

BIC:

Bayesian information criterion

AIC:

Akaike information criterion

Ref:

Reference category

BMI:

Body mass index

HTN:

Hypertension

SE:

Standard error

HR:

Hazard ratio

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Acknowledgements

This study has been extracted from a master’s thesis (in progress, with code IR.TBZMED.REC.1398.1203). We thank Tabriz University of Medical Sciences for financial support.

Funding

Tabriz University of Medical Sciences supported our study in data collection and analysis of data.

Author information

Authors and Affiliations

  1. Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, 5165665931, Tabriz, Iran

    Navideh Nikmohammadi, Neda Gilani & Parvin Sarbakhsh

  2. Epidemiology Healthy Ageing Research Center, Department of Statistics and Epidemiology, Faculty of Health, Neyshabur University of Medical Sciences, Neyshabur, Iran

    S. Morteza Shamshirgaran

Authors
  1. Navideh Nikmohammadi
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  2. Neda Gilani
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  3. S. Morteza Shamshirgaran
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  4. Parvin Sarbakhsh
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Contributions

Navideh Nikmohammadi performed the analyses, interpreted the results, and prepared the manuscript. Neda Gilani contributed to comment on the manuscript. Morteza Shamshirgaran was involved in data collection. Parvin Sarbakhsh contributed to the interpretation and clarification of the data and commented on the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Parvin Sarbakhsh.

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Ethical approval

The ethical aspects of this study were approved by the institutional ethics committee of Tabriz University of Medical Sciences, with code IR.TBZMED.REC.1398.1203.

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We confirm that informed consent has been taken from all participants.

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The manuscript is extracted from MSc dissertation in Tabriz University of Medical Sciences. All authors consented publication of manuscript.

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The authors declare no competing interests.

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Nikmohammadi, N., Gilani, N., Shamshirgaran, S.M. et al. Health care providers’ effect on long-term mortality after the first-ever stroke: application of shared frailty survival models. Neurol Sci 43, 4307–4313 (2022). https://doi.org/10.1007/s10072-022-05983-3

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