Geographic differences in relationship between socioeconomic, clinical, urban-rural factors and stroke incidence in France

Abstract

Background: Stroke remains a devastating disease in Europe and geographic disparities persist. Mapping spatial distributions of disease occurrence can serve as a useful tool for identifying exposures of public health concern. The purpose of this study was to investigate geographic differences in relationship between socioeconomic, clinical, urban-rural factors and stroke incidence in Pays de Brest (Western France) between 2008 and 2013.Methods: We used cases and patient’s characteristics from the Brest stroke registry, and sociodemographic, urban –rural indicators constructed at the census blocks level. We generated maps using Poisson geographic weighted regression models, smoothing on longitude and latitude while adjusting for covariates. Results: Women living in more deprived census blocks evidenced a significantly higher age standardized stroke incidence risk 1.24, [95%CI 1.09-1.39] and 1.21, [95%CI 1.04-1.49], in rural and urban census blocks respectively. For men, three clusters of census blocks with high stroke incidence risk were detected, one in rural and deprived and two in urban and low deprived census bocks. Conclusions: Understand whether and how neighborhood and patient’s characteristics influence stroke risk, may be useful for both epidemiological research and health services planning.