From the Department of Neurology (E.V., J.I.V., N.A.H., F.-E.D.L.), Radboud University Medical Center, Donders Institute for Brain, Cognition and Behavior, Nijmegen; and Department of Epidemiology (I.V.), Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, the Netherlands.
Neurology. 2024 Dec 24;103(12):e210102. doi: 10.1212/WNL.0000000000210102. Epub 2024 Nov 25.
Multiple studies found a higher ischemic stroke incidence in rural areas compared with urbanized areas, often explained by a low socioeconomic status (SES). However, this has rarely been investigated specifically in younger adults. We aimed to investigate the age-specific (15-49 years vs 50+ years) incidence of ischemic stroke in rural and urbanized municipalities within the Netherlands.
Patients with a first-ever ischemic stroke (15 years or older) between 1998 and 2018 were included in this registry-based study through linkage of Dutch national hospital administrative registries. Ischemic stroke was defined through and codes. The urbanization grade of the municipality was defined by the address density in 5 subgroups (from most urban ≥2,500 addresses per km to rural <500 addresses per km). The urbanization grade-specific incidence rate per 100,000 person-years, standardized for age and sex, and incidence rate ratios (IRRs) were calculated. In addition, we performed stratified analyses for young age groups (15-39 and 40-49 years) and neighborhood SES (nSES), which was calculated using welfare, level of education, and recent labor participation.
In total, 23,720 patients aged 15-49 years (median age 44.7 years [interquartile range (IQR) 40.6-48.8], 51.6% women) and 369,107 patients aged older than 50 years (median age 76.7 years [IQR 68.8-84.7], 50.8% women) were included. Patients aged 15-49 years living in rural areas showed a 5% higher risk of ischemic stroke (IRR 1.05 [99% CI 0.98-1.13]) compared with patients in urbanized areas, whereas for persons aged 50 years and older, this risk was decreased by 3% (IRR 0.97 [99% CI 0.95-0.98]). For patients aged 15-39 years, this risk was 20% higher (IRR 1.20 [99% CI 1.05-1.37]), and for patients aged 40-49 years, the risk did not differ (IRR 1.01 [99% CI 0.93-1.09]). The rural-urban disparities in all age groups remained similar when stratified for nSES.
The incidence of ischemic stroke is higher among persons aged 15-49 years living in rural areas compared with urban areas, which was driven by a risk-increase in patients 15-39 years. This was reversed among persons aged 50 years and older. Our findings were not fully explained by differences in nSES. This suggests that different age-specific predictors might play a role in rural-urban disparities in ischemic stroke incidence.
多项研究发现，与城市化地区相比，农村地区的缺血性中风发病率更高，这通常归因于较低的社会经济地位（SES）。然而，这在年轻成年人中很少被专门研究过。我们旨在调查荷兰农村和城市化市的特定年龄（15-49 岁与 50 岁以上）缺血性中风发病率。
本研究通过荷兰国家医院管理登记处的链接，纳入了 1998 年至 2018 年间首次发生缺血性中风（15 岁或以上）的患者。通过 和 代码定义缺血性中风。通过地址密度将市的城市化等级定义为 5 个亚组中的一个（最城市化的等级为≥2500 个地址/平方公里，而最农村的等级为<500 个地址/平方公里）。按年龄和性别标准化的每 100,000 人年发病率，以及发病率比（IRR）进行计算。此外，我们还对年轻年龄组（15-39 岁和 40-49 岁）和邻里 SES（nSES）进行了分层分析，nSES 是通过福利、教育水平和最近的劳动参与来计算的。
共纳入 23720 名年龄在 15-49 岁的患者（中位年龄 44.7 岁[四分位距（IQR）40.6-48.8]，51.6%为女性）和 369107 名年龄大于 50 岁的患者（中位年龄 76.7 岁[IQR 68.8-84.7]，50.8%为女性）。与城市化地区的患者相比，居住在农村地区的 15-49 岁的患者发生缺血性中风的风险高 5%（IRR 1.05[99%置信区间（CI）0.98-1.13]），而对于 50 岁及以上的患者，这种风险降低了 3%（IRR 0.97[99%CI 0.95-0.98]）。对于 15-39 岁的患者，这种风险增加了 20%（IRR 1.20[99%CI 1.05-1.37]），而对于 40-49 岁的患者，风险没有差异（IRR 1.01[99%CI 0.93-1.09]）。在按 nSES 分层的所有年龄组中，农村与城市之间的发病差异仍然相似。
与城市化地区相比，居住在农村地区的 15-49 岁人群发生缺血性中风的发病率更高，这主要归因于 15-39 岁患者的风险增加。这在 50 岁及以上的患者中得到了逆转。我们的研究结果不能完全用邻里 SES 的差异来解释。这表明，不同的年龄特异性预测因素可能在农村和城市缺血性中风发病率差异中发挥作用。
