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Population risk factors for hospitalization for stroke in Scotland
J M Starr1, B Thomas, L J Whalley
1Division of Geriatric Medicine, Hammersmith Hospital, London, UK.
Insights
Geographical variations in cerebrovascular disease (CVD) incidence in Scotland are linked to population risk factors and urban environments. Higher CVD rates in men and women correlate with factors like blood pressure, alcohol, smoking, and deprivation.
Area of Science:
- Epidemiology
- Public Health
- Cardiovascular Research
Background:
- Cerebrovascular disease (CVD) incidence shows significant geographical variation across Scotland.
- This study investigates the relationship between this spatial heterogeneity and population-level risk factors.
Purpose of the Study:
- To identify and correlate geographical variations in cerebrovascular disease (CVD) incidence with population risk factors in Scotland.
- To explore the influence of socioeconomic and lifestyle factors on CVD distribution.
Main Methods:
- Utilized linked national hospital discharge data from 1984-1986 for individuals diagnosed with CVD (ICD-9 430-438).
- Correlated age-sex specific CVD rates with deprivation scores and estimated population risk factors across 22 Scottish local government districts.
- Employed multiple linear regression to analyze associations.
Main Results:
- CVD incidence was higher in men across most districts, with significant associations for male admissions linked to population density and deprivation.
- Elevated diastolic blood pressure, higher alcohol consumption, and lower fruit intake were associated with increased male CVD rates.
- For women, CVD was associated with elevated diastolic blood pressure, smoking, and lower fruit consumption, particularly in densely populated, deprived areas.
- Vitamin C intake was identified as explaining the sex difference in CVD rates.
Conclusions:
- Geographical disparities in cerebrovascular disease (CVD) rates within Scotland are demonstrably linked to specific population risk factors.
- Environmental factors, including population density and deprivation, play a significant role in the observed geographical variation of CVD.
Background:
There is considerable heterogeneity of cerebrovascular disease (CVD) incidence throughout Scotland. We sought to relate this geographical variation to differences in population risk factors.
Method:
A computer search of linked national hospital discharge data was performed. Individuals were selected if they had been coded with a diagnosis of CVD (ICD-9 430-438), 1984-1986. Age-sex specific rates were correlated to deprivation score and estimated population risk factors for the 22 local government districts of the Scottish Heart Health Study (1984-1986).
Results:
Men were more commonly admitted in all districts except one, with an overall male:female ratio of 1.43 (P < 0.0001). Rates for men were significantly higher in populations with elevated mean diastolic blood pressure, greater mean alcohol consumption, and where fewer men ate fruit. The most significant associations of male CVD hospital admissions were with population density and deprivation. A similar pattern was found for women, where CVD was significantly associated with elevated diastolic blood pressure, more smokers and fewer non-smokers, and fewer eating fruit. Again rates were higher in densely populated, deprived districts. Multiple linear regression identified the proportion for men. Sex difference was explained by vitamin C intake.
Conclusion:
Geographical variation in CVD rates in Scotland is related to identifiable population risk factors for atherosclerosis and urban environment.