Stroke Incidence and Case Fatality According to Rural or Urban Residence

Abstract

Background and Purpose— Recent findings suggest that in the United States, stroke incidence is higher in rural than in urban areas. Similar analyses in other high-income countries are scarce with conflicting results. In 2008, the Brest Stroke Registry was started in western France, an area that includes about 366 000 individuals living in various urban and rural settings. Methods— All new patients with stroke included in the Brest Stroke Registry from 2008 to 2013 were classified as residing in town centers, suburbs, isolated towns, or rural areas. Poisson regression was used to analyze stroke incidence and 30-day case fatality variations in the 4 different residence categories. Models with case fatality as outcome were adjusted for age, stroke type, and stroke severity. Results— In total, 3854 incident stroke cases (n=2039 women, 53%) were identified during the study period. Demographic and socio-economic characteristics and primary healthcare access indicators were significantly different among the 4 residence categories. Patterns of risk factors, stroke type, and severity were comparable among residence categories in both sexes. Age-standardized stroke rates varied from 2.90 per thousand (95% CI, 2.59–3.21) in suburbs to 3.35 (95% CI, 2.98–3.73) in rural areas for men, and from 2.14 (95% CI, 2.00–2.28) in town centers to 2.34 (95% CI, 2.12–2.57) in suburbs for women. Regression models suggested that among men, stroke incidence was significantly lower in suburbs than in town centers (incidence rate ratio =0.87; 95% CI, 0.77–0.99). Case fatality risk was comparable across urban categories but lower in rural patients (relative risk versus town centers: 0.76; 95% CI, 0.60–0.96). Conclusions— Stroke incidence was comparable, and the 30-day case fatality only slightly varied in the 4 residence categories despite widely different socio-demographic features covered by the Brest Stroke Registry.

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

“…To complete, our study reveal no differences in the presence of cardiovascular disease, or in term of severity between men patients within the three clusters. Grimaud et al, a recent study in Pays de Brest have found same results; patterns of risk factors, stroke type and severity were comparable among urban categories in both sexes (28). In Japan, a large population based prospective study reported the impact of neighborhood deprivation level on stroke incidence even after adjustment for individual socioeconomic indicators (29).…”

Acute Stroke Care in Mexico City: The Hospital Phase of a Stroke Surveillance Study

“…Therefore, these two chronic diseases are still the main stroke risk factors, which is consistent with a previous population study conducted in 2008. The high prevalence of hypertension and insufficient control explain the high proportion of hemorrhagic strokes, particularly in younger patients, compared with populations in Europe [ 18 , 19 , 20 ], and Asia [ 21 , 22 ], but with notable similarities when compared with other Latino and Japanese populations [ 23 , 24 , 25 , 26 ].…”

9New metrics for assessing linkage quality in deterministic record linkage of health databases

“…The first study used nine years 2009-2017 contained in the Brest Stroke Registry (4264 stroke events for 3985 patients). The Brest Stroke Registry collects data mostly from three neighboring hospitals, but also out-patient data (from general practitioners, three neurologists in private practice, private radiology centers, and nursing homes) and data for death certificates providing data for fatal stroke among non-hospitalized subjects [22]. Each The second study used a cancer trial on oropharyngeal tumours named Artome and run by the Cancer Treatment Centre Eugène Marquis in Rennes.…”