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People who live in rural Ontario at greatest risk of stroke


Ontario adults who live in rural communities have more stroke risk factors and are at greater risk of having a stroke than Ontarians who live in cities, according to a new study by researchers at ICES, a non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues.

The study published today in the journal Circulation: Cardiovascular Quality and Outcomes, shows that adults who live in rural communities and have never had a stroke have more risk factors like smoking, obesity, and heavy alcohol consumption than those living in cities. As well, adults in rural communities were less likely to be screened and treated for conditions like diabetes and high cholesterol, which can also increase stroke risk.

“We found that rural residence is associated with an increased rate of stroke and death, and this was partly but not fully explained by an increased frequency of stroke risk factors. This suggests the need not only for improved management of vascular risk factors, but also further research to understand and address other determinants of health in rural settings,” says Dr. Moira Kapral, lead author of the study and a senior scientist at ICES.

In the study, rural communities were defined as those with a population size of less than 10, 000 people.

The researchers looked at data from 2008 to 2012 for more than six million adults living in Ontario. The researchers found rural residents who had never had a previous stroke were less likely than urban ones to be screened for diabetes (70.9 per cent vs. 81.3 per cent) and high cholesterol (66.2 per cent vs. 78.4 per cent) and less likely to have their diabetes under control (51.3 per cent vs. 54.3 per cent).

“Our findings demonstrate the need to improve access to primary care in rural regions and to raise awareness of risk factors such as smoking and obesity,” adds Kapral.

The researchers also found that rural residents were more likely than urban ones to smoke cigarettes (24.9 per cent vs. 18.5 per cent), be obese (24.3 per cent vs. 18.8 per cent) and have heavy alcohol consumption (16.0 per cent vs. 11.6 per cent).

The researchers also looked at data on more than 70,000 people who had had a previous stroke and did not find the same discrepancies between urban and rural residence.

“In contrast, we did not observe major rural-urban differences in risk factor prevalence or management in those with prior stroke, suggesting that once someone has had a stroke, the established stroke network of care across Ontario does a good job caring for patients regardless of where they live,” says Dr. Albert Jin, co-author on the study and medical director of the Stroke Network of Southeastern Ontario.

This research was funded in part by the Heart and Stroke Foundation.

Author block: Kapral MK, Austin PC, Jeyakumar G, Hall R, Chu A, Khan AM, Jin AY, Martin C, Manuel D, Silver FL, Swartz RH, Tu JV.

The report “Rural-urban differences in stroke risk factors, incidence, and mortality in people with and without prior stroke: the CANHEART stroke study,” is published in the February 14 issue of Circulation: Cardiovascular Quality and Outcomes.

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario


Deborah Creatura
Media Advisor, ICES
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