Stroke Risk Factors and Rurality

The purpose of this analysis is to compare the incidence of strokes related to risk factors and geographic characteristics such as incidence of high blood pressure, high cholesterol, rate of the population that performs cholesterol screening, use of high cholesterol medicine, uninsured rates, race, and rurality for each county and state.

For the period 2007-2017 rural death rates were higher than urban rates for the seven major causes of death analyzed including, congestive heart failure, stroke, cancer, diabetes, unintentional injury, suicide, and chronic obstructive pulmonary disease (COPD) (Yaemsiri et al., 2019). In 2017, stroke death rates were 8 percent higher in rural areas than in urban areas (Yaemsiri et al., 2019). Rural areas have significantly higher rates of cardiovascular risk factors compared with urban areas, whereby rural populations are significantly older than urban and suburban populations and have higher rates of diabetes, obesity, and hypertension (Parker et al., 2018).

Analyzing the Data

This data represents the most current publicly available information sources that are commonly used to study health care trends. The data is derived from the Data Sources listed below and combined to support the analysis.

CDC PLACES Data (data released March 2021)

County Health Ranking (data released 2021)

This data is also available in a text-based table format.

Tutorial: Using the Data

Defining the Columns

A blank entry indicates unreported data. A value of zero is a defined value and does not represent unreported data.

State: The abbreviation of the state.

County: The name of the county. County names are listed as provided on the U.S. Census Bureau's list of 2020 FIPS Codes for Counties and County Equivalent Entities.

Geography: Based on the Core Based Statistical Areas include Metropolitan and Micropolitan Statistical Areas. 

  • Rural: areas that have a population of fewer than 10,000.
  • Metropolitan: areas that have at least one urbanized area of 50,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.
  • Micropolitan: areas that have at least one urban cluster of at least 10,000 but less than 50,000 population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.

Percent Uninsured: Percentage of people under age 65 without insurance. The reporting period for this measure is 2018 from the Small Area Health Insurance Estimates (SAHIE) program.

Percent Stroke: Respondents aged ≥18 years who report ever having been told by a doctor, nurse, or other health professional that they have had a stroke. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent High Blood Pressure: Percentage of respondents aged ≥18 years who report ever having been told by a doctor, nurse, or other health professionals that they have high blood pressure. Women who were told high blood pressure only during pregnancy and those who were told they had borderline hypertension were not included. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent High Cholesterol: Percentage of respondents that received a cholesterol screening in the past 5 years aged ≥18 years who report having been told by a doctor, nurse, or other health professionals that they had high cholesterol. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2018.

Percent with Cholesterol Screening: Percentage of respondents aged ≥18 years who report having their cholesterol checked within the previous 5 years. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2017.

Percent Taking High Blood Pressure Medicine: Percentage of respondents aged ≥18 years who report having been told by a doctor, nurse, or other health professionals of having high blood pressure other than during pregnancy who report taking medicine for high blood pressure. The measure is provided by the Behavioral Risk Factor Surveillance System (BRFSS) survey. Data is only provided for counties with more than 50 respondents to the BRFSS survey and is from 2017.

Percent Asian: The proportion of the county’s population that falls into the racial or ethnic category of Asian from the U.S. Census Bureau Population Estimates from 2019.

Percent Black: The proportion of the county’s population that falls into the racial or ethnic category of Black from the U.S. Census Bureau Population Estimates from 2019.

Percent Hispanic: The proportion of the county’s population that falls into the racial or ethnic category of Hispanic from the U.S. Census Bureau Population Estimates from 20198.

Percent Native Hawaiian or Other Pacific Islander: The proportion of the county’s population that falls into the racial or ethnic category of Native Hawaiian or Other Pacific Islander from the U.S. Census Bureau Population Estimates from 2019.

Percent Native American: The proportion of the county’s population that falls into the racial or ethnic category of Native American from the U.S. Census Bureau Population Estimates from 2019.

Percent White: The proportion of the county’s population that falls into the racial or ethnic category of White from the U.S. Census Bureau Population Estimates from 2019.

This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program Grantees, $1,560,000 (0% financed with nongovernmental sources). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.