The U-shaped association between urbanization and post-stroke disability: A nationwide longitudinal study in China

Q1 Social Sciences
Hengyi Liu , Mingkun Tong , Man Cao , Jiajianghui Li , Hong Lu , Ruohan Wang , Xinyue Yang , Tianjia Guan , Tao Xue , Yuanli Liu
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Abstract

Background

In the 21st century, China experienced a rapid increase in urbanization, which has enhanced medical service availability, but has also increased exposure to adverse environmental and socioeconomic factors. Urbanization-related factors can affect the prognosis of stroke patients, particularly the progression of neurological disabilities. However, the overall association between urbanization and post-stroke disability remains unknown.

Method

A total of 21,678 stroke patients were selected from the China National Stroke Screening Survey (2013–2018); all included patients had at least one follow-up record. The modified Rankin Scale (mRS), a clinician-reported functional outcome measure for recovery from stroke, was utilized to assess post-disability at each visit. A larger mRS score means severer disability. The urbanization level before each visit was evaluated based on 5-year average satellite measurements of night-time light (NTL) or urban land cover (i.e., proportion of impervious surface). We used a fixed-effects model to estimate the association between urbanization level and risk of disability (i.e., mRS score). The non-linear relationship was modelled by penalized spline functions.

Results

According to linear models with multivariate adjustment, every 10 digital number (DN) increment in NTL was associated with a 0.050 (95% confidence interval [CI]: 0.026, 0.074) increase in mRS score, and every 10% increment in impervious surface was associated with a 0.052 (95% CI: 0.034, 0.070) increase in mRS score. The association was stronger in patients diagnosed with atrial fibrillation, dyslipidemia, hypertension, or diabetes compared with the corresponding reference group. Non-linear analysis showed a U-shaped relationship between urbanization and the mRS score, which indicates that high and low urbanization levels were both associated with an increased risk of post-stroke disability.

Conclusions

Our study revealed a complex association between urbanization and post-stroke disability. The optimal level of urbanization to prevent neurological disabilities in stroke patients could be inferred from the U-shaped curve. The reasons for the complex association between urbanization and post-stroke disability should be further explored to establish causality.

城市化与脑卒中后残疾的U型关联:一项全国性的纵向研究
背景在21世纪,中国经历了城市化的快速发展,这提高了医疗服务的可用性,但也增加了对不利环境和社会经济因素的暴露。城市化相关因素会影响中风患者的预后,尤其是神经功能障碍的进展。然而,城市化与脑卒中后残疾之间的总体联系仍然未知。方法从中国脑卒中筛查调查(2013-2018)中选择21678例脑卒中患者;所有纳入的患者都至少有一次随访记录。改良的兰金量表(mRS)是一种临床医生报告的中风康复的功能结果测量方法,用于评估每次就诊时的残疾后情况。mRS评分越大,残疾程度越严重。每次访问前的城市化水平是根据5年平均卫星测量的夜间光线(NTL)或城市土地覆盖(即不透水表面的比例)进行评估的。我们使用固定效应模型来估计城市化水平与残疾风险之间的关系(即mRS评分)。非线性关系由惩罚样条函数建模。结果根据多变量校正的线性模型,NTL每增加10个数字(DN),mRS评分就会增加0.050(95%置信区间[CI]:0.0260.074),不透水表面每增加10%,mRS得分就会增加0.052(95%可信区间:0.034,0.070)。与相应的参考组相比,被诊断为心房颤动、血脂异常、高血压或糖尿病的患者的相关性更强。非线性分析显示,城市化与mRS评分之间呈U型关系,这表明高和低城市化水平都与卒中后残疾风险增加有关。结论我们的研究揭示了城市化与脑卒中后残疾之间的复杂联系。从U型曲线可以推断出预防脑卒中患者神经功能障碍的最佳城市化水平。城市化与脑卒中后残疾之间复杂关联的原因应进一步探讨,以建立因果关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Global Transitions
Global Transitions Social Sciences-Development
CiteScore
18.90
自引率
0.00%
发文量
1
审稿时长
20 weeks
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