Abstract
BackgroundRural communities have a higher burden of cardiovascular risk factors than urban communities. In Sweden, socioeconomic transition and urbanization have led to decreased populations in rural areas and changing characteristics of the remaining inhabitants. We investigated the risk factors in urban and rural populations in Northern Sweden.MethodsThe 2009 Northern Sweden MONICA Study invited a random sample of 2,500 people, 25 to 74 years and 69.2% participated. Community size was classified as rural = <1,000 inhabitants, town = 1,000-15,000, or urban/city= >15,000. We adjusted our analysis for age, gender and education.ResultsThe rural population was older and the proportion of men was higher than in the urban areas. Having only primary education was more common in rural areas than in urban areas (26.2% vs. 12.3%). Waist and hip circumference, body mass index (BMI), and total cholesterol levels were higher in rural areas than in urban areas, even after adjusting for differences in age and gender. The largest differences between rural and urban dwellers were seen in waist circumference of women (4.8 cm), BMI of women (1.8 units) and cholesterol of men (0.37 mmol/l). Blood pressure was higher in rural areas, but not after adjusting for age and gender.Participants in rural areas were more often treated for hypertension and hyperlipidaemia, hospitalized for myocardial infarction and diagnosed with diabetes. However, after adjusting for age and gender, there were no differences. The odds ratio for being physically active comparing rural areas to urban areas was 0.73 (95% CI 0.53; 1.01). Smoking, snuff use and the prevalence of pathological glucose tolerance did not differ between community sizes. Middle-sized communities often had values in between those found in rural and urban communities, but overall they were more similar to the rural population. Further adjustment for education did not change the results for any variable.ConclusionsIn 2009 the rural population in northern Sweden was older, with less education, higher BMI, more sedentary lifestyle, and had higher cholesterol levels than the urban population. The rural population should be considered targets for focused preventive interventions, but with due consideration of the socioeconomic and cultural context.
Highlights
Rural communities have a higher burden of cardiovascular risk factors than urban communities
In the USA and England cardiovascular disease (CVD) mortality is higher in rural regions than in urban regions [1,2]
All differences were statistically significant in pairwise comparisons between groups, by post hoc analysis with Tukey LSD test, except between women living in towns or rural areas
Summary
Rural communities have a higher burden of cardiovascular risk factors than urban communities. We investigated the risk factors in urban and rural populations in Northern Sweden. Data from Sweden are sparse, but official statistics show that regions dominated by rural communities have a higher incidence of myocardial infarction (MI) and stroke in both women and men [3]. The incidence and mortality for MI and stroke have declined more rapidly in northern than in southern Sweden in the last decades, but there are still large geographical variations within the two northernmost counties of Norrbotten and Västerbotten [4]. The Northern Sweden MONICA Study recently reported large reductions in all risk factors except obesity and diabetes in Norrbotten and Västerbotten counties between 1986 and 2009 [6]
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