Journal of Urban Health

, Volume 84, Issue 4, pp 604–614 | Cite as

Urbanization and Stroke Prevalence in Taiwan: Analysis of a Nationwide Survey

  • Herng-Ching Lin
  • Yen-Ju Lin
  • Tsai-Ching Liu
  • Chin-Shyan Chen
  • Wen-Ta Chiu
Article
First Online:
Received:
Accepted:

Abstract

This study aims to explore the prevalence of strokes among individuals and the association with urbanization levels. A total sample of 9,794 individuals was obtained from a nationwide survey on Taiwan for subsequent analysis in this study. After adjusting for gender, age, other risk factors for stroke and individual socioeconomic status, a multivariate logistic regression model was employed to investigate the relationships existing between the prevalence of strokes and the level of urbanization. This study finds that those living in areas at the highest level of urbanization (level 1) had the highest prevalence of strokes (2.49%). With decreasing urbanization level, there was a general decline in stroke prevalence. After adjusting for other factors, the multivariate logistic regression analyses showed that compared to participants living in the highest urbanization level, the respective odds ratios of suffering a stroke for those living in areas at the lowest levels of urbanization (levels 7 and 8), were 0.43 and 0.30. We conclude that after adjusting for other stroke risk factors, the level of urbanization is an important contributory factor to the overall prevalence of strokes in Taiwan.

Keywords

Stroke Urbanization Health Policy 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgement

This study was supported by Topnotch Stroke Research Center Grant, Ministry of Education, Taiwan.

References

  1. 1.
    Berger K, Schulte H, Stogbauer F, Assmann G. Incidence and risk factors for stroke in an occupational cohort: The PROCAM study. Stroke. 1998;29:1562–1566.PubMedGoogle Scholar
  2. 2.
    Caroline TM, Hendrike M, Monique MB, Grobbee DE, Mackenbach JP. Socioeconomic differences in stroke among Dutch elderly women: The Rotterdam study. Stroke. 1999;30:357–362.Google Scholar
  3. 3.
    Cinzia S, Daiva R, Zygimantas C, Jaakko T. Internal trends in mortality from stroke, 1968 to 1994. Stroke. 2000;31:1588–1601.Google Scholar
  4. 4.
    Cox AM, McKevitt C, Rudd AG, Wolfe CDA. Socioeconomic status and stroke. Lancet Neurol. 2006;5:181–188.PubMedCrossRefGoogle Scholar
  5. 5.
    Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham study. Stroke. 1991;22:312–318.PubMedGoogle Scholar
  6. 6.
    Hart CL, Hole D, Smith GD. The contribution of risk factors to smoke differentials, by socioeconomic position in adulthood: The Renfrew/Paisley study. Am J Public Health. 2000;90:1788–1791.PubMedGoogle Scholar
  7. 7.
    Jakovljevic D, Sarti C, Sivenius J, et al. Socioeconomic status and ischemic stroke: The FINMONICA stroke register. Stroke. 2001;32:1492–1498.PubMedGoogle Scholar
  8. 8.
    World Health Qrganization. World health report 2004 changing history. Geneva:World Health Qrganization; 2004 (Statistical Annex).Google Scholar
  9. 9.
    Boysen G, Nyboe J, Appleyard M, et al. Stroke Incidence and risk factors for stroke in Copenhagen, Denmark. Stroke. 1988;19:1345–1353.PubMedGoogle Scholar
  10. 10.
    Diez-Roux AV, Link B, Northridge ME. A multilevel analysis of income inequality and cardiovascular disease risk factors. Soc Sci Med. 2000;50:673–687.PubMedCrossRefGoogle Scholar
  11. 11.
    Mensah GA, Mokdad AH, Ford ES, Greenlund KJ, Croft JB. State of disparities in cardiovascular health in the United States. Circulation. 2005;111:1233–1241.PubMedCrossRefGoogle Scholar
  12. 12.
    Duncan GJ, Daly MC, McDonough P, Williams DR. Optimal indicators of socioeconomic status for health research. Am J Public Health. 2002;92:1151–1157.PubMedCrossRefGoogle Scholar
  13. 13.
    Gillum RF, Mussolino ME. Education, poverty, and stroke incidence in whites and blacks: The NHANES I epidemiologic follow-up study. J Clin Epidemiol. 2003;56:188–195.PubMedCrossRefGoogle Scholar
  14. 14.
    Grundy E, Holt G. The socioeconomic status of older adults: How should we measure it in studies of health inequalities? J Epidemiol Community Health. 2001;55:895–904.PubMedCrossRefGoogle Scholar
  15. 15.
    Jakovljevic D, Sarti C, Sivenius J, et al. Socioeconomic differences in the incidence, mortality and prognosis of intracerebral hemorrhage in Finnish adult population: The FINMONICA stroke register. Neuroepidemiology. 2001;20:85–90.PubMedCrossRefGoogle Scholar
  16. 16.
    Jakovljevic D, Sarti C, Sivenius J, et al. Socioeconomic inequalities in the incidence, mortality and prognosis of subarachnoid hemorrhage: The FINMONICA stroke register. Cerebrovasc Dis. 2001;12:7–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Krieger N, Williams DR, Moss NE. Measuring social class in U.S. public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378.PubMedCrossRefGoogle Scholar
  18. 18.
    Brown P, Guy M, Broad J. Individual socio-economic status, community socio-economic status and stroke in New Zealand: a case control study. Soc Sci Med. 2005;61:1174–1188.PubMedCrossRefGoogle Scholar
  19. 19.
    Modan B, Wagener DK. Some epidemiological aspects of stroke: mortality/morbidity trends, age, sex, race, socioeconomic status. Stroke. 1992;23:1230–1236.PubMedGoogle Scholar
  20. 20.
    Engstrom G, Jerntorp I, Pessah-Rasmussen H, et al. Geographic distribution of stroke incidence within an urban population: relations to socioeconomic circumstances and prevalence of cardiovascular risk factors. Stroke. 2001;32:1098–1103.PubMedGoogle Scholar
  21. 21.
    Jiang B, Wang WZ, Chen HL, et al. Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke. 2006;37:63–68.PubMedCrossRefGoogle Scholar
  22. 22.
    Health Statistics [in Chinese]. Executive Yuan, Taipei, Taiwan: Department of Health. Available at: http://www.doh.gov.tw. Taiwan.
  23. 23.
    Shih YT, Chang HY, Le KH [in Chinese]: Introduction to the National Health Interview Survey (NHIS). Vol 1. NHIS Brief Communication. 2002.Google Scholar
  24. 24.
    Tzeng GH, Wu TY. Characteristics of urbanization level in Taiwan districts. Geographical Res. 1986;12:287–323.Google Scholar
  25. 25.
    Lin HC, Kao S, Tang CH, Chang WY. Using a population-based database to explore the inter-specialty differences in physician practice incomes in Taiwan. Health Policy. 2005;73:253–262.PubMedCrossRefGoogle Scholar
  26. 26.
    Lin HC, Chen CS, Liu TC, Lee HC. Differences in practice income between solo and group practice physicians. Health Policy. 2006;79:296–305.PubMedCrossRefGoogle Scholar
  27. 27.
    AI-Moosa S, Allin S, Jemiai N, AI-Lawati J, Mossialos E. Diabetes and urbanization in the Omani population: an analysis of national survey data. Popul Health Metr. 2006;4:1–20.CrossRefGoogle Scholar
  28. 28.
    Hall SA, Kaufman JS, Millikan RC, Ricketts TC, Herman D, Savitz DA. Urbanization and breast cancer incidence in North Carolina, 1995–1999. Ann Epidemiol. 2005; 15:796–803.PubMedCrossRefGoogle Scholar
  29. 29.
    Nicolaou N, Siddique N, Custovic A. Allergic disease in urban and rural populations: increasing prevalence with increasing urbanization. Allergy. 2005;60:1357–1360.PubMedCrossRefGoogle Scholar
  30. 30.
    Viinanen A, Munhbayarlah S, Zevgee T, et al. Prevalence of asthma, allergic rhinoconjunctivitis and allergic sensitization in Mongolia. Allergy. 2005;60:1370–1377.PubMedCrossRefGoogle Scholar
  31. 31.
    Anlar O, Tombul T, Unal O, Kayan M. Seasonal and environment temperature variation in the occurance of ischemic strokes and intracerebral hemorrhage in a Turkish adult population. Intern J Neurosci. 2002; 112:959–963.CrossRefGoogle Scholar
  32. 32.
    Azevedo E, Ribeiro JA, Lopes F, Martins R, Barros H. Cold: a risk factor for stroke? J Neurol. 1995;242:217–221.PubMedCrossRefGoogle Scholar
  33. 33.
    Feigin VL, Anderson CS, Anderson NE, Broad JB, Pledger MJ. Is there a temporal pattern in the occurance of subarachnoid hemorrhage in the southern hemisphere? Pooled data from 3 large, population-based incidence studies in Australia, 1981–1997. Stroke. 2001;32:613–619.PubMedGoogle Scholar
  34. 34.
    Feigin VL, Anderson CS, Rodgers A, Bennett DA. Subarachnoid haemorrhage occurance exhibits a temporal pattern—evidence from meta-analysis. Eur J Neurol. 2002;9:511–516.PubMedCrossRefGoogle Scholar
  35. 35.
    Hong YC, Lee JT, Kim H, Kown HJ. Air pollution: a new risk factor in ischemic stroke mortality. Stroke. 2002;33:2165–2169.PubMedCrossRefGoogle Scholar
  36. 36.
    Jonas BS, Mussolino ME. Symptoms of depression as a prospective risk factor for stroke. Psychosom Med. 2000;62:463–471.PubMedGoogle Scholar
  37. 37.
    Ramasubbu R, Patten SB. Effect of depression on stroke morbidity and mortality. Can J Psychiatry. 2003;48:250–257.PubMedGoogle Scholar
  38. 38.
    Davis PH, Dambrosia JM, Schoenberg BS, et al. Risk factors for ischemic stroke: a prospective study in Rochester, Minnesota. Ann Neurol. 1987;22:319–327.PubMedCrossRefGoogle Scholar
  39. 39.
    Gill JS, Zezulka AV, Shipley MJ, et al. Stroke and alcohol consumption. N Engl J Med. 1986;315:1041–1046.PubMedCrossRefGoogle Scholar
  40. 40.
    Reynolds K, Gu D, Muntner P, et al. Alcohol consumption and risk of stroke: a meta-analysis. JAMA. 2003;289:579–588.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2007

Authors and Affiliations

  • Herng-Ching Lin
    • 1
  • Yen-Ju Lin
  • Tsai-Ching Liu
  • Chin-Shyan Chen
  • Wen-Ta Chiu
  1. 1.School of Health Care AdministrationTaipei Medical UniversityTaipeiTaiwan

Personalised recommendations