Abstract P201: Rural/Urban Differences in the Prevalence of Stroke Risk Factors

Abstract

Introduction: Despite previously reported higher stroke (and heart disease) mortality in rural areas, there are few data on the presence or magnitude of rural-urban disparities in the prevalence of stroke risk factors. Methods: Participants (n = 28,242) of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were categorized into the 6-level ordinal National Center for Health Statistics Urban-Rural Classification Scheme. The prevalence of 6 traditional risk factors (hypertension, diabetes, cigarette smoking, atrial fibrillation, left ventricular hypertrophy and heart disease) and estimated 10-year risk of stroke (indexed by the Framingham Stroke Risk Function score) was assessed across the rural-urban scale in models adjustment for demographic factors (age, race, sex, and state of residence) and after further adjustment for community-level socioeconomic status disadvantage. Results: Hypertension, diabetes and heart disease were all more prevalent in rural regions (p < 0.05); with respective odds 1.25-times (95% CI: 1.11 - 1.42), 1.15-times (95% CI: 0.99 - 1.33), and 1.19-times (95% CI: 1.02 - 1.39) greater in the most rural as compared to the most urban regions (see Table). The estimated 10-year risk of stroke was also greater in rural areas; however, the estimated magnitude of increased stroke risk was relatively small. Adjustment for neighborhood-level socioeconomic status disadvantage attenuated some, but not all, of these relationships (for example, hypertension OR: 1.25 to 1.21, diabetes OR: 1.15 to 1.00, heart disease OR: 1.19 to 1.10). Discussion: These data suggest that while some of the increased stroke mortality in rural areas may be due to an increased burden of stroke risk factors in rural areas, the contribution of risk factors is quite inconsistent across the rural-urban spectrum. This association was attenuated by the adjustment for socioeconomic status, which suggests that some of the higher stroke risk in rural counties may be due to their lower level of socioeconomic status.