Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China.
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ABSTRACT:
SUBMITTER: Mi T
PROVIDER: S-EPMC4829046 | biostudies-other | 2016 May
REPOSITORIES: biostudies-other
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Project description:Objective:The increased blood pressure level in children and adolescents is recognized as an essential predictor of adulthood cardiovascular disease. This study aimed to ascertain the prevalence and the urban-rural disparity of childhood hypertension in the southwest of China. Methods:Using stratified cluster sampling in urban and rural areas, a total of 13597 primary school children aged 6?12 years living in the Southwest of China were included. The prevalence of hypertension was analyzed. The risk factors were collected by questionnaires, and the risk factors of childhood hypertension were analyzed by the logistic regression model. Results:The prevalence of hypertension was 13.75%, 9.02%, and 17.47% in total, urban, and rural children, respectively, and the urban-rural difference was 8.44% (95%CI: 7.32%, 9.56%). Children with obesity, maternal gestational hypertension, >10 months of breastfeeding, or low family income had a significantly increased prevalence of hypertension (29.4%, 20.00%, 16.31%, and 16.25%, respectively). Rural residence, intake of more pickle (in rural), maternal gestational hypertension (in urban), low birth weight (in rural), obesity, increased heart rate, and red blood cell counts were the risk factors of childhood hypertension. The adjusted R 2 values were 13.61%, 23.25%, 10.88%, 11.12%, 12.23%, and 25.04% in the full models excluding and including serum indexes for total, urban, and rural children, respectively. Conclusions:The prevalence of childhood hypertension is significant in the Southwest of China and alarming in rural areas, which requires community intervention. Children living in rural areas combined with obesity, low social economic status, dietary imbalance, and abnormal lipid metabolism were associated with an increased risk of hypertension, and routine care programs should be conducted to prevent childhood hypertension.
| S-EPMC7240786 | biostudies-literature
Project description:Ideal cardiovascular health (CVH) has been defined by the American Heart Association as the lack of cardiovascular disease and the presence of seven key factors and health behaviors. In this study, we aimed to estimate the prevalence of ideal and poor CVH among the Polish adult population based on the example of the inhabitants of Janów district in Lubelskie Voivodship, taking the chosen socio-demographic factors into consideration. This is a cross-sectional study conducted among 3901 adults without cardiovascular diseases, aged between 35 and 64 years. Participants completed a questionnaire, and they had anthropometric and physiological measurements taken. Blood samples were analyzed for fasting glucose and cholesterol levels. Ideal CVH was found in 5.4% of the participants, with the advantage of being toward city dwellers over those living in the rural areas (6.3% vs. 5.0%) p = 0.02. In the case of the residents of rural areas, their likelihood of having an ideal body mass index (BMI) was found to be 22% lower (odds ratio (OR) = 0.78; 95% CI: 0.66?0.92), their likelihood of having an ideal diet was found to be 27% lower (OR = 0.71; 95% CI: 0.54?0.94), their likelihood of having perfect blood pressure was found to be 29% lower (OR = 0.71; 95% CI: 0.56?0.89), and their likelihood of having the perfect glucose levels was found to be 28% lower (OR = 0.72; 95% CI: 0.63?0.84), than the residents of urban areas. The prevalence of ideal cardiovascular behaviors and factors is lower in the rural community compared with people living in the city. Results indicate that more effort should be dedicated toward the country's health policy, specifically concerning primary prevention. Preventive actions in the field of cardiovascular disease should be addressed to the residents of rural areas to a larger extent.
| S-EPMC6266283 | biostudies-literature
Project description:To assess differences in cardiovascular risk profiles among rural-to-urban migrants and non-migrant groups.Cross-sectional study in Ayacucho and Lima, Peru. Participants were: rural (n=201); rural-to-urban migrants (n=589); and urban (n=199). Cardiovascular risk factors were assessed according to migrant status (migrants vs non-migrants), age at first migration, length of residency in an urban area and lifetime exposure to an urban area.For most risk factors, the migrant group had intermediate levels of risk between those observed for the rural and urban groups. Prevalence for rural, migrant and urban groups was 3%, 20% and 33%, respectively, for obesity, and 0.8%, 3% and 6% for type-2 diabetes. This gradient of risk was not observed uniformly across all risk factors. Blood pressure did not show a clear gradient of difference between groups. The migrant group had similar systolic blood pressure but lower diastolic blood pressure than the rural group. The urban group had higher systolic blood pressure but similar diastolic blood pressure than rural group. Hypertension was more prevalent among the urban (29%) than both the rural and migrant groups (11% and 16%, respectively). For HbA(1c), although the urban group had higher levels, the migrant and rural groups were similar to each other. No differences were observed in triglycerides between the three groups. Within migrants, those who migrated when aged older than 12 years had higher odds of diabetes, impaired fasting glucose and metabolic syndrome compared to people who migrated at younger ages. Adjustment for age, sex and socioeconomic indicators had little impact on the patterns observed.The impact of rural-to-urban migration on cardiovascular risk profile is not uniform across different risk factors, and is further influenced by the age at which migration occurs. A gradient in levels was observed for some risk factors across study groups. This observation indicates that urbanisation is indeed detrimental to cardiovascular health.
| S-EPMC3183994 | biostudies-literature
Project description:BackgroundNutritional habits low in fruits and vegetables and sedentary lifestyle are associated with a higher risk of developing Type 2 Diabetes (T2D). However, it is important to assess differences between urban and rural areas. This study aimed to analyze the associations between the risk of developing T2D and setting in the Colombian north coast in 2017.MethodsThis cross-sectional study included 1,005 subjects. Data was collected by interviewing self-identified members of an urban community and a rural-indigenous population. The interaction terms were evaluated as well as the confounders. Then, adjusted binary logistic regressions were used to estimate the odds ratio (OR) and 95% Confidence Intervals (CI).Resultssubjects with a high risk of T2D are more likely to belong to the urban setting (OR = 1.908; 95%CI = 1.201-2.01) compared with those with lower T2D after adjusting for age, Body Mass Index (BMI), physical activity, history of high levels of glycemia, and diabetes in relatives.ConclusionsUrban communities are more likely to have T2D compared with rural-indigenous populations. These populations have differences from the cultural context, including personal, and lifestyle factors.
| S-EPMC8732783 | biostudies-literature
Project description:Background: Many regions worldwide reported a decline of stroke admissions during the early phase of the coronavirus disease 2019 (COVID-19) pandemic. It remains unclear whether urban and rural regions experienced similar declines and whether deviations from historical admission numbers were more pronounced among specific age, stroke severity or treatment groups. Methods: We used registry datasets from (a) nine acute stroke hospitals in Berlin, and (b) nine hospitals from a rural TeleNeurology network in Northeastern Germany for primary analysis of 3-week-rolling average of stroke/TIA admissions before and during the COVID-19 pandemic. We compared course of stroke admission numbers with regional cumulative severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) infections. In secondary analyses, we used emergency department logs of the Berlin Charité University hospital to investigate changes in age, stroke severity, and thrombolysis/thrombectomy frequencies during the early regional Sars-CoV-2 spread (March and April 2020) and compared them with preceding years. Results: Compared to past years, stroke admissions decreased by 20% in urban and 20-25% in rural hospitals. Deviations from historical averages were observable starting in early March and peaked when numbers of regional Sars-CoV-2 infections were still low. At the same time, average admission stroke severity and proportions of moderate/severe strokes (NIHSS >5) were 20 and 20-40% higher, respectively. There were no relevant deviations observed in proportions of younger patients (<65 years), proportions of patients with thrombolysis, or number of thrombectomy procedures. Stroke admissions at Charité subsequently rebounded and reached near-normal levels after 4 weeks when the number of new Sars-CoV-2 infections started to decrease. Conclusions: During the early pandemic, deviations of stroke-related admissions from historical averages were observed in both urban and rural regions of Northeastern Germany and appear to have been mainly driven by avoidance of admissions of mildly affected stroke patients.
| S-EPMC7815522 | biostudies-literature
Project description:BackgroundIn Haiti, differences in the prevalence of anemia between urban and rural areas have been observed.ObjectiveTo identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti.MethodsThis cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5-13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect.ResultsIn rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, ([Formula: see text] = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32-3.18)], age [AOR = 0.89; 95%CI (0.85-0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67-0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed.ConclusionsIn this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.
| S-EPMC8023464 | biostudies-literature
Project description:BACKGROUND:Equity is one of the major goals of China's new medical reforms launched in 2009. This study aimed to analyze the disequilibrium in primary health care (PHC) workforce among various economic zones in China and to compare the fairness between urban and rural areas since the implementation of the new medical reforms. METHOD:According to China's 11th Five-Year Plan, China is divided into eight economic regions. The data of this study were obtained from China Statistical Yearbook 2009-2016. The Atkinson index was used to depict the trend of PHC workforce fairness; the Gini coefficient was used to compare the fairness of workforce distribution between urban and rural areas; the health resource agglomeration degree was used to analyze the distributional equity of the workforce in the eight regions; and the Theil Index was used to compare the fairness of urban and rural workforce distribution across eight regions. RESULT:The Atkinson index indicated that the equity of the entire PHC workforce allocation had generally improved during the new medical reforms; the Gini coefficient indicated that the fairness of the entire workforce allocation had improved in cities, but only the nurse allocation became fairer in rural areas. The agglomeration degree and the Theil index indicated that the fairness gaps across the eight regions were still large. These analyses differed from previous studies where China was divided into western, central and eastern regions. In what was previously defined as eastern region, the northeast was under-resourced, while the eastern coastal areas were observing a resource surplus. In western region, we found that the fairness in the northwest was significantly worse than southwest. CONCLUSION:In China, the distribution of healthcare workforce has been improved with continuous effort. The gaps in the distribution of PHC workforce across different economic regions and between urban and rural areas are still large, with different regions facing different problems. The government should consider the population and geographical factors in allocation of PHC workforce, especially nurses.
| S-EPMC7045560 | biostudies-literature
Project description:Importance:In China, diabetes prevalence has increased substantially in recent decades, but there are no reliable estimates of the excess mortality currently associated with diabetes. Objectives:To assess the proportional excess mortality associated with diabetes and estimate the diabetes-related absolute excess mortality in rural and urban areas of China. Design, Setting, and Participants:A 7-year nationwide prospective study of 512?869 adults aged 30 to 79 years from 10 (5 rural and 5 urban) regions in China, who were recruited between June 2004 and July 2008 and were followed up until January 2014. Exposures:Diabetes (previously diagnosed or detected by screening) recorded at baseline. Main Outcomes and Measures:All-cause and cause-specific mortality, collected through established death registries. Cox regression was used to estimate adjusted mortality rate ratio (RR) comparing individuals with diabetes vs those without diabetes at baseline. Results:Among the 512?869 participants, the mean (SD) age was 51.5 (10.7) years, 59% (n?=?302?618) were women, and 5.9% (n?=?30?280) had diabetes (4.1% in rural areas, 8.1% in urban areas, 5.8% of men, 6.1% of women, 3.1% had been previously diagnosed, and 2.8% were detected by screening). During 3.64 million person-years of follow-up, there were 24?909 deaths, including 3384 among individuals with diabetes. Compared with adults without diabetes, individuals with diabetes had a significantly increased risk of all-cause mortality (1373 vs 646 deaths per 100?000; adjusted RR, 2.00 [95% CI, 1.93-2.08]), which was higher in rural areas than in urban areas (rural RR, 2.17 [95% CI, 2.07-2.29]; urban RR, 1.83 [95% CI, 1.73-1.94]). Presence of diabetes was associated with increased mortality from ischemic heart disease (3287 deaths; RR, 2.40 [95% CI, 2.19-2.63]), stroke (4444 deaths; RR, 1.98 [95% CI, 1.81-2.17]), chronic liver disease (481 deaths; RR, 2.32 [95% CI, 1.76-3.06]), infections (425 deaths; RR, 2.29 [95% CI, 1.76-2.99]), and cancer of the liver (1325 deaths; RR, 1.54 [95% CI, 1.28-1.86]), pancreas (357 deaths; RR, 1.84 [95% CI, 1.35-2.51]), female breast (217 deaths; RR, 1.84 [95% CI, 1.24-2.74]), and female reproductive system (210 deaths; RR, 1.81 [95% CI, 1.20-2.74]). For chronic kidney disease (365 deaths), the RR was higher in rural areas (18.69 [95% CI, 14.22-24.57]) than in urban areas (6.83 [95% CI, 4.73-9.88]). Among those with diabetes, 10% of all deaths (16% rural; 4% urban) were due to definite or probable diabetic ketoacidosis or coma (408 deaths). Conclusions and Relevance:Among adults in China, diabetes was associated with increased mortality from a range of cardiovascular and noncardiovascular diseases. Although diabetes was more common in urban areas, it was associated with greater excess mortality in rural areas.
| S-EPMC6520233 | biostudies-literature
Project description:BackgroundPostpartum Family Visits (PFVs) have been advocated as a way to improve health outcomes for puerperal women and their newborns. This study aimed to identify individual factors associated with the utilization of PFVs in rural Jiangsu Province, China.MethodsWe employed responses of the household survey in Jiangsu province, part of the National Health Service Survey (NHSS), a nationally representative survey in China. The data analysis framework was designed based on Andersen's behavioral model. The outcome variables included nonuse and deficient use of PFVs, and the explanatory variables were organized into three hierarchical levels: predisposing, enabling and need factors. Univariate analysis and multivariate logistic regression analysis were conducted to examine the impact of the three hierarchical levels on PFVs utilization.ResultsA total of 884 rural women who had a childbearing history in the prior five years answered PFVs questions. About 23.4% of them had never received any PFVs, and 40.4% received <3 visits. In the results of multivariate logistic regression, educational level (OR = 0.43, 95% CI: 0.24-0.77), income (OR = 0.62, 95% CI: 0.43-0.88), the distance from the nearest hospital (OR = 1.49, 95% CI: 1.07-2.07) and parity (OR = 2.17, 95% CI: 1.54-3.05) had significant relationship with nonuse. Factors significantly associated with deficient use of PFVs included employment (OR = 0.62, 95% CI: 0.39-0.98), the distance from the nearest hospital (OR = 1.73, 95% CI: 1.26-2.36), level of delivery institution (OR = 1.57, 95% CI: 1.14-2.17), and parity (OR = 1.45, 95% CI: 1.03-2.05).ConclusionThe study found lower Social Economic Status (SES), long distance with primary health institutions, and the increased need for services stemming from multi-parity reduced the likelihood of nonuse or deficient use of PFVs in rural areas. Multiparous, low SES women and those living far away from primary health institutions should be paid more attention to assure the coverage of postpartum care.
| S-EPMC5863976 | biostudies-literature
Project description:We aimed to assess the association between urban/rural residence and the risk of ischemic stroke in individuals with newly diagnosed atrial fibrillation (AF), and to quantify the role of oral anticoagulation (OAC) initiation in the variation in stroke risk between urban and rural residents with AF. Using 5% random samples of Medicare claims, we identified fee-for-service beneficiaries who were diagnosed with AF between January 2014 and December 2015. Beneficiaries were followed for 1 year since their AF diagnosis, and were categorized according to their initiation of OAC within the year. We used the Rural-Urban Continuum Codes to define urban (levels 1 to 3) and rural (levels 4 to 9) areas. We applied marginal structural models to examine to what extent the difference in stroke risk between rural and urban areas were attributable to the difference in OAC initiation. In the year of AF diagnosis, 52% of those residing in urban areas and 56% residing in rural areas initiated an OAC (p <0.001). Urban residence, compared with rural residence, was associated with a 22% (hazard ratio and 95% confidence interval: 1.22 [1.13, 1.31]) increased risk of stroke. The hazard ratio attributed to urban residence decreased to 1.14 (1.01, 1.30) after accounting for the mediating role of lack of OAC initiation. Lack of OAC initiation explained 34% of the increased stroke risk observed in urban areas. In conclusion, urban residents with newly diagnosed AF were less likely to initiate OAC than rural counterparts, which explained one third of the increased risk of stroke observed in urban areas.
| S-EPMC8040970 | biostudies-literature