![]() ![]() 3 Such regional variations are in part attributable to variations in the prevalence of vascular risk factors, such as hypertension, diabetes mellitus, smoking, and atrial fibrillation, as well as factors such as obesity, sedentary lifestyle, alcohol consumption, diet, and socioeconomic deprivation. 1, 2 Although there have been temporal declines in stroke incidence and mortality in most high-income countries, regional variations persist, and stroke mortality has increased in some subgroups. Stroke is a leading cause of death and disability worldwide. After adjustment for sociodemographic and comorbid conditions, rural residence was associated with higher rates of stroke and all-cause mortality in both the primary prevention (adjusted hazard ratio for stroke, 1.06 95% CI, 1.04–1.09 aHR for mortality, 1.09 95% CI, 1.08–1.10) and the secondary prevention cohort (aHR for stroke, 1.11 95% CI, 1.02–1.19 aHR for mortality, 1.07 95% CI, 1.03–1.11). In the secondary prevention cohort, the prevalence and treatment of risk factors were similar in rural and urban residents. In the primary prevention cohort, rural residents were less likely than urban ones to be screened for diabetes mellitus (70.9% versus 81.3%) and hyperlipidemia (66.2% versus 78.4%) and less likely to achieve diabetes mellitus control (hemoglobin A1c ≤7% in 51.3% versus 54.3% P<0.001 for all comparisons). We then calculated sex-/age-standardized rates of stroke incidence and mortality per 1000 person-years between Januand Decemand used cause-specific hazard models to compare outcomes in rural versus urban areas adjusting for age, sex, income, ethnicity, smoking, physical activity and comorbid conditions, and accounting for the competing risk of death in the model for the occurrence of stroke incidence. We defined rural communities as those with a population size of ≤10 000 and within each of the primary and secondary prevention cohorts, compared cardiovascular risk factors and care between rural and urban areas. ![]() We used the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) cohort, created from linked administrative databases from the province of Ontario, Canada, and divided into primary (N=6 207 032) and secondary (N=75 823) prevention cohorts based on the absence or presence of prior stroke. ![]() Customer Service and Ordering Information.About Circ: Cardiovascular Quality and Outcomes.Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB). ![]()
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