18 Jun Increase In Risk Factors Contribute To More Strokes in Rural Areas

MedicalResearch.com Interview with:

Dr. Howard

George Howard, Dr.PH
PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study
Department of Biostatistics
University of Alabama at Birmingham
Birmingham, AL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Rural areas have been known to have a higher death rate than urban, and higher death from stroke in rural areas is a major contributor to this disparity.

The goal of the research was to assess if the higher deaths from stroke was because rural people are more likely to have a stroke, or more likely to die from a stroke once it occurs.   This distinction is critically important, since intervention to reduce stroke deaths in rural area would focus on stroke prevention if the former, but would focus on improving stroke care (after the stroke) if the latter.

We found that the higher mortality from stroke appears to be almost completely due to more people having stroke.   As such, we need to focus on efforts to reduce the risk of rural areas.   While there are well-documented differences in stroke care between urban and rural areas, resolving these differences will not be likely reduce the rural excess death from stroke.

It would seem that the higher risk of having a stroke could be due to the observation that those in rural areas are more likely to have major stroke risk factors, including hypertension, diabetes and cigarette smoking; however, the higher prevalence of these risk factors don’t seem to explain the higher risk.   So what causes the higher risk remains a mystery.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Focus should be on prevention of stroke in rural areas.

While important to also reduce disparities in stroke care, these reductions are unlikely to make large differences to reduce the rural excess risk of dying from stroke.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The next steps are to understand why there is a higher risk of having a stroke in rural areas.

The “under the streetlamp” reasons are to look at factors that are lead to higher stroke risk … including hypertension, diabetes and cigarette smoking.   However, this work also showed that these are not likely to be the main reasons for the higher risk of stroke in rural areas.   Hence, we need to understand why this is happening.  

MedicalResearch.com: Is there anything else you would like to add?

Response: To to fix a problem (such as why more people in rural areas die from stroke), you have to understand why the problem is happening.

This work is the first step in this effort. 

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation: 

Contributors to the Excess Stroke Mortality in Rural Areas in the United States
George Howard, Dawn O. Kleindorfer, Mary Cushman, D. Leann Long, Adam Jasne, Suzanne E. Judd, John C. Higginbotham, Virginia J. Howard
Stroke. 2017;STROKEAHA.117.017089

Originally published June 16, 2017

http://stroke.ahajournals.org/content/early/2017/06/16/STROKEAHA.117.017089

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

Last Updated on June 18, 2017 by Marie Benz MD FAAD