Department of Medicine, University of Arizona-Tucson, UA College of Medicine, 6th Floor, Room 6336, 1501 N. Campbell Ave, Tucson, AZ 85724, United States.
Department of Medicine, University of Arizona-Tucson, UA College of Medicine, 6th Floor, Room 6336, 1501 N. Campbell Ave, Tucson, AZ 85724, United States.
J Stroke Cerebrovasc Dis. 2024 Aug;33(8):107762. doi: 10.1016/j.jstrokecerebrovasdis.2024.107762. Epub 2024 May 7.
Disparities in stroke outcomes, influenced by the use of systemic thrombolysis, endovascular therapies, and rehabilitation services, have been identified. Our study assesses these disparities in mortality after stroke between rural and urban areas across the United States (US).
We analyzed the CDC data on deaths attributed to cerebrovascular disease from 1999 to 2020. Data was categorized into rural and urban regions for comparative purposes. Age-adjusted mortality rates (AAMR) were computed using the direct method, allowing us to examine the ratios of rural to urban deaths for the cumulative population and among demographic subpopulations. Linear regression models were used to assess temporal changes in mortality ratios over the study period, yielding beta-coefficients (β).
There was a total of 628,309 stroke deaths in rural regions and 2,556,293 stroke deaths within urban regions. There were 1.13 rural deaths for each one urban death per 100,000 population in 1999 and 1.07 in 2020 (β = -0.001, p = 0.41). The rural-urban mortality ratio in Hispanic populations decreased from 1.32 rural deaths for each urban death per 100,000 population in 1999 to 0.85 in 2020 (β = -0.011, p < 0.001). For non-Hispanic populations, mortality remained stagnant with 1.12 rural deaths for each urban death per 100,000 population in 1999 and 1.07 in 2020 (β = -0.001, p = 0.543). Regionally, the Southern US exhibited the highest disparity with a urban-rural mortality ratio of 1.19, followed by the Northeast (1.13), Midwest (1.04), and West (1.01).
Our findings depict marked disparities in stroke mortality between rural and urban regions, emphasizing the importance of targeted interventions to mitigate stroke-related disparities.
已确定，由于系统性溶栓、血管内治疗和康复服务的使用，中风结局存在差异。我们的研究在美国（US）评估了农村和城市地区中风死亡率的这些差异。
我们分析了 1999 年至 2020 年期间疾病控制与预防中心（CDC）关于归因于脑血管疾病的死亡数据。为了比较目的，数据分为农村和城市地区。使用直接法计算年龄调整死亡率（AAMR），使我们能够检查累积人口和人口亚群中农村与城市死亡的比例。线性回归模型用于评估研究期间死亡率比值的时间变化，产生β系数（β）。
在农村地区共有 628309 例中风死亡，在城市地区有 2556293 例中风死亡。1999 年，每 10 万人口中有 1.13 例农村死亡，而 2020 年为 1.07 例（β=-0.001，p=0.41）。1999 年，西班牙裔人群中每 10 万人口有 1.32 例农村死亡，而 2020 年降至 0.85 例（β=-0.011，p<0.001）。对于非西班牙裔人群，每 10 万人口中有 1.12 例农村死亡，1999 年和 2020 年保持不变（β=-0.001，p=0.543）。在区域方面，美国南部地区的差异最大，城乡死亡率比为 1.19，其次是东北部（1.13）、中西部（1.04）和西部（1.01）。
我们的研究结果表明，农村和城市地区的中风死亡率存在显著差异，这强调了需要采取有针对性的干预措施来减轻与中风相关的差异。
