The Perils of Life in the Country

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New study helps to explain why strokes are more common in rural communities than in cities.
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This study found that the incidence of stroke-related death is 19% higher in Ontarians who live in the country than in those who live in the city.
Every summer, many Torontonians leave the city—along with its noise, traffic and crowds—for a relaxing vacation at a cottage. It is widely believed that the trees, fresh air and slower pace of country life are beneficial to our mental and physical health.
 
Despite these benefits, living in the country can have disadvantages. For example, stroke and stroke-related deaths are more common in rural communities than urban centres.
 
A stroke occurs when blood stops flowing to a part of the brain, which can lead to brain damage. This damage can cause permanent disabilities, including paralysis, memory loss and difficulty swallowing or talking. The risk of stroke can be lowered through a healthy lifestyle and medications.
 
Dr. Moira Kapral, a Senior Scientist at the Toronto General Hospital Research Institute, led a study to better understand why rural residents are at a higher risk of stroke than their urban counterparts.
 
By examining the health records of more than 6.2 million Ontarians, she discovered that rural residents were more likely than urban residents to smoke, be obese, consume large amounts of alcohol or have poor heart health. Each of these factors increases the risk of stroke. 
 
Her findings also indicated that rural residents were less likely to be screened for stroke risk factors, such as diabetes and high cholesterol, and that these factors were less likely to be controlled through medications or lifestyle changes.
 
“Our findings support the need for enhanced identification and management of stroke risk factors in rural settings. Further research is also needed to identify other factors—such as variations in care, income or education—that are linked to higher rates of stroke in rural communities,” says Dr. Kapral.
 
This study was supported by the Institute for Clinical Evaluative Sciences, the Ontario Ministry of Health and Long-Term Health, the Heart and Stroke Foundation of Canada, the Canadian Institutes of Health Research and the Toronto General & Western Hospital Foundation. J Tu held a Tier 1 Canada Research Chair in Health Services Research.
 
Kapral MK, Austin PC, Jeyakumar G, Hall R, Chu A, Khan AM, Jin AY, Martin C, Manuel D, Silver FL, Swartz RH, Tu JV. Rural-Urban Differences in Stroke Risk Factors, Incidence, and Mortality in People With and Without Prior Stroke. Circ Cardiovasc Qual Outcomes. 2019 Feb. doi: 10.1161/CIRCOUTCOMES.118.004973.