Hengyi Liu , Mingkun Tong , Man Cao , Jiajianghui Li , Hong Lu , Ruohan Wang , Xinyue Yang , Tianjia Guan , Tao Xue , Yuanli Liu
{"title":"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","authors":"Hengyi Liu , Mingkun Tong , Man Cao , Jiajianghui Li , Hong Lu , Ruohan Wang , Xinyue Yang , Tianjia Guan , Tao Xue , Yuanli Liu","doi":"10.1016/j.glt.2023.01.001","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Method</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":33615,"journal":{"name":"Global Transitions","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The U-shaped association between urbanization and post-stroke disability: A nationwide longitudinal study in China\",\"authors\":\"Hengyi Liu , Mingkun Tong , Man Cao , Jiajianghui Li , Hong Lu , Ruohan Wang , Xinyue Yang , Tianjia Guan , Tao Xue , Yuanli Liu\",\"doi\":\"10.1016/j.glt.2023.01.001\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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.</p></div><div><h3>Method</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":33615,\"journal\":{\"name\":\"Global Transitions\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Global Transitions\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589791823000014\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"Social Sciences\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Global Transitions","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589791823000014","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"Social Sciences","Score":null,"Total":0}
The U-shaped association between urbanization and post-stroke disability: A nationwide longitudinal study in China
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.