Stroke Risk Factors and Rurality

Strokes are a serious health problem that can cause disability or death. But what are the factors that increase the risk of having a stroke and how does where you live affect your chances of surviving a stroke? These are some of the questions that this analysis tries to answer by looking at data from different counties and states in the U.S.

People who live in rural areas are more likely to die from strokes than people who live in urban areas. In fact, in 2019, rural areas had higher death rates from strokes than urban areas (CDC, 2021). This difference has been consistent over time, and it is partly explained by the fact that rural areas have more people who are older and have more health problems that can lead to strokes, such as diabetes, obesity, and high blood pressure (Parker et al., 2018).

Another important finding is that high cholesterol is a major risk factor for strokes. However, many people who have high cholesterol do not know it or do not treat it properly. Rural areas have lower rates of cholesterol screening and lower use of cholesterol medicine than urban areas, which means that many people in rural areas may have undiagnosed or untreated high cholesterol that puts them at risk of strokes.

This analysis shows that strokes are a major public health problem that affects regions and populations differently. The data suggests that improving access to health care and promoting healthy behaviors could prevent and treat strokes and save lives. By understanding the causes and consequences of strokes, action can be taken to improve the health and well-being of communities.

This data is also available as an Excel spreadsheet.

Stroke2024.xlsx (521.15 KB)

Data Sources
Data Definitions

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.

Centers for Disease Control and Prevention (CDC) PLACES Data (data released 2024)
County Health Rankings (data released 2024)

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

FIPS: The federal information processing standard (FIPS) code for the geographic location.

State: The abbreviation of the state.

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

Uninsured Rate: The estimated number of individuals in the county under age 65 without health insurance. Data is from the Small Area Health Insurance Estimates (SAHIE) Program from 2021.

Children in Poverty Rate: The percentage of children under age 18 living in poverty. Poverty status is defined by family; either everyone in the family is in poverty or no one in the family is in poverty. Data is from the Small Area Income Poverty Estimates (SAIPE) in 2022.

Premature Age-Adjusted Mortality: Number of deaths among residents under age 75 per 100,000 population (age-adjusted). The reporting period for this measure is 2019 through 2021 from CDC WONDER mortality data.

Child Mortality: Number of deaths among residents under age 18 per 100,000 population. The 2024 County Health Rankings used data from 2018-2021 for this measure.

Infant Mortality: Number of infant deaths (within 1 year) per 1,000 live births. The 2024 County Health Rankings used data from 2015-2021 for this measure.

Uninsured Adults Rate: Percentage of adults under age 65 without health insurance. The 2024 County Health Rankings used data from 2021 for this measure.

Uninsured Children Rates: Percentage of children under age 19 without health insurance. The 2024 County Health Rankings used data from 2021 for this measure.

Population Size: The total number of individuals residing in the county. The data is derived from the Census Population Estimates from 2022.

Percent Black: The proportion of the county’s population that falls into the racial or ethnic category of Black from the US Census Bureau Population Estimates from 2022.

Percent Asian: The proportion of the county’s population that falls into the racial or ethnic category of Asian from the US Census Bureau Population Estimates from 2022.

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 US Census Bureau Population Estimates from 2022.

Percent Hispanic: The proportion of the county’s population that falls into the racial or ethnic category of Hispanic from the US Census Bureau Population Estimates from 2022.

Percent White: The proportion of the county’s population that falls into the racial or ethnic category of White from the US Census Bureau Population Estimates from 2022.

% Rural: The percentage of the county population living in a census-defined rural area.

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 2021.

Percent High Blood Pressure: Percentage of respondents aged ≥18 years who report ever having been told by a doctor, nurse, or other health professional 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 2021.

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 professional 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 2021.

Percent Taking High Blood Pressure Medicine: Percentage of respondents aged ≥18 years who report having been told by a doctor, nurse, or other health professional 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 2021.

Visits to Doctor: Percentage of respondents greater than 18 years old who report having been to a doctor for a routine checkup (e.g., a general physical exam, not an exam for a specific injury, illness, condition) in the previous year. Data is from the Behavioral Risk Factor Surveillance System (BRFSS).

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 2021.

Population Type: The population type is determined based on the population size of a specific county. The population types include metro, nonmetro cities, and nonmetro towns. These types are adapted from the rural-urban commuting area codes (RUCA) and core-based statistical areas (CBSA) definitions of rural and urban. The population types for counties are defined as follows:

Metro - A population of 50,000 or more
Nonmetro cities - A population between 2,500 and less than 50,000
Nonmetro towns - A population of less than 2,500

Tutorial Video

In this tutorial video, we look at Stroke Risk Factors and Rurality. The video guides you through how to use Tableau data analysis to compare the incidence of strokes related to risk factors and geographic characteristics.