Stroke Incidence and Case Fatality According to Rural or Urban Residence

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.

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Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population

Stroke ◽

10.1161/strokeaha.115.009797 ◽

2015 ◽

Vol 46 (10) ◽

pp. 2728-2734 ◽

Cited By ~ 10

Author(s):

Chuen Seng Tan ◽

Falk Müller-Riemenschneider ◽

Sheryl Hui Xian Ng ◽

Pei Zheng Tan ◽

Bernard P.L. Chan ◽

...

Keyword(s):

Case Fatality ◽

Asian Population ◽

Day Case ◽

Stroke Incidence ◽

Stroke Registry

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Association between county-level risk groups and COVID-19 outcomes in the United States: a socioecological study

BMC Public Health ◽

10.1186/s12889-021-12469-y ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Sadiya S. Khan ◽

Amy E. Krefman ◽

Megan E. McCabe ◽

Lucia C. Petito ◽

Xiaoyun Yang ◽

...

Keyword(s):

United States ◽

Rural Areas ◽

Urban Areas ◽

Latent Class ◽

Communicable Disease ◽

Local Level ◽

Healthcare Access ◽

The United States ◽

County Level ◽

Health Factors

Abstract Background Geographic heterogeneity in COVID-19 outcomes in the United States is well-documented and has been linked with factors at the county level, including sociodemographic and health factors. Whether an integrated measure of place-based risk can classify counties at high risk for COVID-19 outcomes is not known. Methods We conducted an ecological nationwide analysis of 2,701 US counties from 1/21/20 to 2/17/21. County-level characteristics across multiple domains, including demographic, socioeconomic, healthcare access, physical environment, and health factor prevalence were harmonized and linked from a variety of sources. We performed latent class analysis to identify distinct groups of counties based on multiple sociodemographic, health, and environmental domains and examined the association with COVID-19 cases and deaths per 100,000 population. Results Analysis of 25.9 million COVID-19 cases and 481,238 COVID-19 deaths revealed large between-county differences with widespread geographic dispersion, with the gap in cumulative cases and death rates between counties in the 90th and 10th percentile of 6,581 and 291 per 100,000, respectively. Counties from rural areas tended to cluster together compared with urban areas and were further stratified by social determinants of health factors that reflected high and low social vulnerability. Highest rates of cumulative COVID-19 cases (9,557 [2,520]) and deaths (210 [97]) per 100,000 occurred in the cluster comprised of rural disadvantaged counties. Conclusions County-level COVID-19 cases and deaths had substantial disparities with heterogeneous geographic spread across the US. The approach to county-level risk characterization used in this study has the potential to provide novel insights into communicable disease patterns and disparities at the local level.

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P2777Natural history and long-term prognosis of stroke types in urban and rural China: a 9-year prospective study of 0.5 million adults

European Heart Journal ◽

10.1093/eurheartj/ehz748.1094 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

Y Chen ◽

N Wright ◽

R Clarke ◽

C Kartsonaki ◽

I Turnbull ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Recurrent Stroke ◽

Case Fatality ◽

Day Case ◽

Vascular Events ◽

Recurrent Strokes ◽

Long Term Prognosis ◽

Incident Cases

Abstract Background Stroke is a major cause of premature death and disability worldwide. However, relatively little is known about the natural history and long-term prognosis following stroke in many low and middle income countries, including China. Methods The prospective China Kadoorie Biobank recruited 512,000 adults (59% women, mean age 51 years) from 10 (5 urban, 5 rural) areas in China during 2004–08. Information about death and hospitalisation for specific causes was collected by linkage with mortality registries and nationwide health insurance systems. During a 9-year follow-up, 45,732 incident cases of stroke (∼92% confirmed by neuroimaging) were recorded among individuals without prior vascular disease at baseline. The adjusted 28-day case-fatality rates and long-term cumulative risks of recurrent stroke, major vascular events, and mortality following first-ever stroke were estimated by stroke types. Results Of the 45,732 first-ever stroke cases reported, 80% (36,588) had IS, 17% (7440) had intracerebral haemorrhage (ICH), 2% (702) had subarachnoid haemorrhage (SAH), and only 1002 (1%) had an unspecified stroke type. The overall 28-day case-fatality following first stroke was 11%, but increased with age and was higher in those in rural than in urban areas (16% vs 6%) and in men than in women (13% vs 10%). The 28-day case-fatality was highest for ICH (47%), lowest for IS (3%) and intermediate for SAH (19%) and unspecified strokes (24%). Among those who survived beyond 28 days, 17% died (28% for ICH, 16% for IS) and 41% had a recurrent stroke (44% for ICH, 41% for IS) at 5 years. For those with first-ever IS, 91% of the subsequent recurrent strokes involved same pathological type, while for ICH, 41% of the recurrent strokes were IS. Stroke prognosis Conclusions Among Chinese adults, the short- and long-term prognosis following first-ever stroke were poor, highlighting the urgent need to implement more effective treatment and secondary prevention strategies for stroke cases. Acknowledgement/Funding UK MRC, UK Wellcome Trust, British Heart Foundation, Cancer Research UK, The Chinese Ministry of Science and Technology, the Chinese National Science

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Influence of Pre-Existing Mild Cognitive Impairment and Dementia on Post-Stroke Mortality. The Dijon Stroke Registry

Neuroepidemiology ◽

10.1159/000497614 ◽

2019 ◽

Vol 54 (6) ◽

pp. 490-497 ◽

Cited By ~ 4

Author(s):

Mathilde Graber ◽

Lucie Garnier ◽

Sophie Mohr ◽

Benoit Delpont ◽

Christelle Blanc-Labarre ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Cox Regression ◽

Case Fatality ◽

Population Based ◽

Cognitive Status ◽

Stroke Severity ◽

Day Case ◽

Stroke Registry ◽

Dementia Patients

Objective: We assessed the association between pre-stroke cognitive status and 90-day case-fatality. Methods: Patients with ischemic stroke (IS) or spontaneous intracerebral hemorrhage (ICH) were prospectively identified among residents of Dijon, France, between 2013 and 2015, using a population-based registry. Association between pre-stroke cognitive status and case-fatality at 90 days was evaluated using Cox regression. Results: Seven hundred sixty-two patients were identified, and information about pre-stroke cognitive status was obtained for 716 (92.6%) of them, including 603 IS (84.2%) and 113 ICH (15.8%). Before stroke, 99 (13.8%) patients had mild cognitive impairment (MCI) and 98 (13.7%) had dementia. Patients with cognitive impairment were older, had a higher prevalence of several risk factors, more severe stroke, more frequent ICH, and less admission to stroke unit. Case-fatality rate at 90 days was 11.7% in patients without cognitive impairment, 32.3% in MCI patients, and 55.1% in patients with dementia. In multivariable analyses, pre-existing MCI (hazard ratio [HR] 2.22, 95% CI 1.21–4.05, p = 0.009) and dementia (HR 4.35, 95% CI 2.49–7.61, p < 0.001) were both associated with 90-day case-fatality. Conclusion: Pre-stroke MCI and dementia were both associated with increased mortality. These associations were not fully explained by baseline characteristics, pre-stroke dependency, stroke severity or patient management, and underlying reasons need to be investigated.

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The Rural-Urban Continuum of Polarization: Understanding the Geography of the 2018 Midterms

The Forum ◽

10.1515/for-2020-2102 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Kenneth M. Johnson ◽

Dante J. Scala

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Metropolitan Areas ◽

Political Attitudes ◽

The United States ◽

Rural America ◽

Rural Regions ◽

Urban America ◽

Urban And Rural Areas ◽

The Continuum

Abstract This study of the 2018 congressional midterms demonstrates how voting patterns and political attitudes vary across a spectrum of urban and rural areas in the United States. Rural America is no more a monolith than is urban America. The rural-urban gradient is better represented by a continuum than a dichotomy. This is evident in the voting results in 2018, just as it was in 2016. We found that the political tipping point lies beyond major metropolitan areas, in the suburban counties of smaller metropolitan areas. Democrats enjoyed even greater success in densely populated urban areas in 2018 than in 2016. Residents of these urban areas display distinctive and consistent social and political attitudes across a range of scales. At the other end of the continuum in remote rural areas, Republican candidates continued to command voter support despite the challenging national political environment. Voters in these rural regions expressed social and political attitudes diametrically opposed to their counterparts in large urban cores.

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Large disparities in 28‐day case fatality by stroke subtype: data from a French stroke registry between 2008 and 2017

European Journal of Neurology ◽

10.1111/ene.14876 ◽

2021 ◽

Author(s):

Victoria Gauthier ◽

Dominique Cottel ◽

Philippe Amouyel ◽

Jean Dallongeville ◽

Aline Meirhaeghe

Keyword(s):

Case Fatality ◽

Day Case ◽

Stroke Subtype ◽

Stroke Registry

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Housing Finance Reform: Should There Be a Government Guarantee?

Quarterly Journal of Finance ◽

10.1142/s2010139211000201 ◽

2011 ◽

Vol 01 (04) ◽

pp. 811-822 ◽

Cited By ~ 1

Author(s):

Richard K. Green

Keyword(s):

Rural Areas ◽

Urban Areas ◽

The United States ◽

Economic Stress ◽

Mortgage Market ◽

Best Interest ◽

Finance Reform ◽

Fixed Rate ◽

The Great Depression ◽

The Republic

In 2007 and 2008, the mortgage market failed. It failed in a number of dimensions: Default rates rose to their highest levels since the great depression, and mortgage liquidity ground to a halt. This failure has produced recriminations: Blame has been laid at the feet of borrowers, brokers, lenders, investment banks, investors and government and quasi-government entities that guaranteed mortgages. These recent events have produced an important debate: Whether the U.S. mortgage market requires a federal guarantee in order to best serve consumers, investors and markets. My view is that such a guarantee is necessary. I will divide my argument into four areas: (1) I will argue that the United States has had a history of providing guarantees, either implicit or explicit, regardless of its professed position on the matter. This phenomenon goes back to the origins of the republic. It is in the best interest of the country to acknowledge the existence of such guarantees, and to price them appropriately before, rather than after, they become necessary. (2) I will argue that in times of economic stress, such as now, the absence of government guarantees would lead to an absence of mortgages. (3) I will argue that a purely "private" market would likely not provide a 30 year fixed rate pre-payable mortgage. I think that this is no longer a particularly controversial statement; what is more controversial is whether such a mortgage is necessary — I will argue that it is. (4) I will argue that in the absence of a federal guarantee, the price and quantity of mortgages will vary across geography. In particular, rural areas will have less access to mortgage credit that urban areas, central cities will have less access than suburbs. Condominiums already are treated less favorably than detached houses, and this difference is likely to get larger in the absence of a guarantee.

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First-Ever Stroke Incidence and 30-Day Case Fatality in the Sicilian Aeolian Archipelago, Italy

Stroke ◽

10.1161/01.str.0000190907.88846.df ◽

2005 ◽

Vol 36 (12) ◽

pp. 2738-2741 ◽

Cited By ~ 19

Author(s):

Rosa Musolino ◽

Paolino La Spina ◽

Salvatore Serra ◽

Paolo Postorino ◽

Salvatore Calabró ◽

...

Keyword(s):

Case Fatality ◽

Day Case ◽

Stroke Incidence ◽

Aeolian Archipelago

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An Academic-Community Collaboration to Deliver Medication Therapy Management (MTM) Services to Patients Living in Rural Counties of a Southwestern State in the United States

Journal of Pharmacy Practice ◽

10.1177/08971900211000219 ◽

2021 ◽

pp. 089719002110002

Author(s):

David Rhys Axon ◽

Melissa Johnson ◽

Brittany Abeln ◽

Stephanie Forbes ◽

Elizabeth J. Anderson ◽

...

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Program Effectiveness ◽

Small Town ◽

The United States ◽

Small Towns ◽

Academic Community ◽

Service Needs ◽

Medication Therapy

Background: Patients living in rural communities often experience pronounced health disparities, have a higher prevalence of diabetes and hypertension, and poorer access to care compared to urban areas. To address these unmet healthcare service needs, an established, academic-based MTM provider created a novel, collaborative program to provide comprehensive, telephonic services to patients living in rural Arizona counties. Objective: This study assessed the program effectiveness and described differences in health process and outcome measures (e.g., clinical outcomes, gaps in care for prescribed medications, medication-related problems) between individuals residing in different rural-urban commuting area (RUCA) groups (urban, micropolitan, and small town) in rural Arizona counties. Methods: Subjects eligible for inclusion were 18 years or older with diabetes and/or hypertension, living in rural Arizona counties. Data were collected on: demographic characteristics, medical conditions, clinical values, gaps in care, medication-related problems (MRPs), and health promotion guidance. Subjects were analyzed using 3 intra-county RUCA levels (i.e., urban, micropolitan, and small town). Results: A total of 384 patients were included from: urban (36.7%), micropolitan (19.3%) and small town (44.0%) areas. Positive trends were observed for clinical values, gaps in care, and MRPs between initial and follow-up consultations. Urban dwellers had significantly lower average SBP values at follow-up than those from small towns (p < 0.05). A total of 192 MRPs were identified; 75.0% were resolved immediately or referred to providers and 16.7% were accepted by prescribers. Conclusion: This academic-community partnership highlights the benefits of innovative collaborative programs, such as this, for individuals living in underserved, rural areas.

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Stroke Incidence and 30-Day Case-Fatality Rates in Novosibirsk, Russia, 1982 Through 1992

Stroke ◽

10.1161/01.str.26.6.924 ◽

1995 ◽

Vol 26 (6) ◽

pp. 924-929 ◽

Cited By ~ 27

Author(s):

Valery L. Feigin ◽

David O. Wiebers ◽

Jack P. Whisnant ◽

W. Michael O’Fallon

Keyword(s):

Case Fatality ◽

Day Case ◽

Stroke Incidence

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