Department of Biostatistics, UAB School of Public Health, 1665 University Drive, University of Alabama at Birmingham, Birmingham, AL 35294-0022, United States of America.
Prev Med. 2021 Nov;152(Pt 2):106661. doi: 10.1016/j.ypmed.2021.106661. Epub 2021 Jun 1.
Rural-urban health disparities in life expectancy are large and increasing, with the rural-urban disparity stroke mortality serving as a potential contributor. Data from Vital Statistics shows an unexplained temporal pattern in the rural-urban disparity in stroke-specific mortality, with the magnitude of the disparity increasing from 15% to 25% between 1999 and 2010, but subsequently decreasing to 8% by 2019. This recent decrease in the magnitude of the rural-urban disparity in stroke mortality appears to be driven by a previously unreported plateauing of stroke mortality in urban areas and a continued decline of stroke mortality in rural areas. There is a need to better understand the contributors to these temporal changes; however, a general lack of temporal data on potential contributors prevents this investigation. However considering contributors to the rural-urban differences pooled across time, an overall a higher stroke incidence in rural areas appears to be a contributor to the higher rural stroke mortality, with this higher incidence potentially associated with a higher prevalence of stroke risk factors in rural areas. Conversely, studies assessing rural-urban disparities in stroke case fatality show smaller and inconsistent associations. To the extent that disparities in case fatality do exist, there are many studies showing rural-urban disparities in stroke care could be contributing. While these data offer insights to the overall rural-urban disparities in stroke mortality, additional data are needed to help understand temporal changes in the magnitude of the rural-urban stroke mortality disparity.
城乡预期寿命存在巨大且不断扩大的健康差距，城乡间卒中死亡率差异是造成这一现象的潜在因素之一。生命统计数据显示，卒中特异性死亡率的城乡差异存在一种无法解释的时间模式，1999 年至 2010 年间，城乡间差异的幅度从 15%增加到 25%，但随后在 2019 年降至 8%。这种城乡间卒中死亡率差异幅度的近期下降似乎是由于城市地区卒中死亡率此前未报告的稳定以及农村地区卒中死亡率的持续下降所致。需要更好地了解这些时间变化的原因；然而，由于缺乏潜在因素的时间数据，因此无法进行这方面的调查。然而，考虑到跨时间的城乡差异的贡献因素，农村地区总体较高的卒中发病率似乎是农村地区较高卒中死亡率的一个原因，这种较高的发病率可能与农村地区较高的卒中风险因素患病率有关。相反，评估卒中病死率城乡差异的研究显示出较小且不一致的关联。在差异确实存在的程度上，有许多研究表明，卒中护理方面的城乡差异可能是造成这种差异的原因。虽然这些数据提供了对卒中死亡率整体城乡差异的深入了解，但还需要更多的数据来帮助理解城乡间卒中死亡率差异幅度的时间变化。
