Rural-Urban Differences in Diagnosed Cervical Artery Dissection in New York State.
Cervical artery dissection
Epidemiology
Rural area
Urban area
Journal
Cerebrovascular diseases (Basel, Switzerland)
ISSN: 1421-9786
Titre abrégé: Cerebrovasc Dis
Pays: Switzerland
ID NLM: 9100851
Informations de publication
Date de publication:
2022
2022
Historique:
received:
30
09
2021
accepted:
19
11
2021
pubmed:
17
1
2022
medline:
7
7
2022
entrez:
16
1
2022
Statut:
ppublish
Résumé
Cervical artery dissection (CeAD) is a leading cause of stroke in young adults. Incidence estimates may be limited by under- or overdiagnosis. We aimed to investigate if CeAD diagnosis would be higher in urban centers compared to rural regions of New York State (NYS). For this ecological study, administrative codes were used to identify CeAD discharges in the NYS Statewide Planning and Research Cooperative System (SPARCS) from 2009 to 2014. Rural Urban Commuting Area (RUCA) codes were taken from the US Department of Agriculture and included the classifications metropolitan, micropolitan, small town, and rural. Negative binomial models were used to calculate effect estimates and 95% confidence limits (eβ; 95% CL) for the association between RUCA classification and the number of dissections per ZIP code. Models were further adjusted by population. Population information was obtained from the US Census Bureau on 1,797 NYS ZIP codes (70.7% of NYS ZIP codes), 826 of which had at least 1 CeAD-related discharge from 2009 to 2014. Nonrural ZIP codes were more likely to report more CeAD cases relative to rural areas even after adjusting for population (metropolitan effect = eβ 5.00; 95% CI: 3.75-6.66; micropolitan effect 3.02; 95% CI: 2.16-4.23; small town effect 2.34; 95% CI: 1.58-3.47). CeAD diagnosis correlates with population density as defined by rural-urban status. Our results could be due to underdiagnosis in rural areas or overdiagnosis with increasing urbanicity.
Sections du résumé
BACKGROUND
Cervical artery dissection (CeAD) is a leading cause of stroke in young adults. Incidence estimates may be limited by under- or overdiagnosis.
OBJECTIVE
We aimed to investigate if CeAD diagnosis would be higher in urban centers compared to rural regions of New York State (NYS).
METHODS
For this ecological study, administrative codes were used to identify CeAD discharges in the NYS Statewide Planning and Research Cooperative System (SPARCS) from 2009 to 2014. Rural Urban Commuting Area (RUCA) codes were taken from the US Department of Agriculture and included the classifications metropolitan, micropolitan, small town, and rural. Negative binomial models were used to calculate effect estimates and 95% confidence limits (eβ; 95% CL) for the association between RUCA classification and the number of dissections per ZIP code. Models were further adjusted by population.
RESULTS
Population information was obtained from the US Census Bureau on 1,797 NYS ZIP codes (70.7% of NYS ZIP codes), 826 of which had at least 1 CeAD-related discharge from 2009 to 2014. Nonrural ZIP codes were more likely to report more CeAD cases relative to rural areas even after adjusting for population (metropolitan effect = eβ 5.00; 95% CI: 3.75-6.66; micropolitan effect 3.02; 95% CI: 2.16-4.23; small town effect 2.34; 95% CI: 1.58-3.47).
CONCLUSIONS
CeAD diagnosis correlates with population density as defined by rural-urban status. Our results could be due to underdiagnosis in rural areas or overdiagnosis with increasing urbanicity.
Identifiants
pubmed: 35034032
pii: 000521204
doi: 10.1159/000521204
pmc: PMC9256775
mid: NIHMS1788792
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
506-510Subventions
Organisme : NINDS NIH HHS
ID : K23 NS107645
Pays : United States
Informations de copyright
© 2022 S. Karger AG, Basel.
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