![]() The most frequently cited feature of sprawl is the abundance of large-lot (usually 1-5 acres depending on the development context), residential housing developments that consume large amounts of previously vacant or productive land. These include:ġ) Low-density, single family dwellings. While there is no universally accepted definition of sprawling land development, there are several common characteristics pervading the literature that can help us understand and even measure its occurrence. The phenomenon of sprawl has been described in various ways, ranging from development aesthetics to local street patterns (Galster et al., 2001). Understanding the causes, consequences, and policy implications related to sprawl can provide important insights on how to construct more sustainable communities over the long term. For years, scientists have argued that sprawling urban and suburban development patterns are creating negative impacts including habitat fragmentation, water and air pollution, increased infrastructure costs, inequality, and social homogeneity (Ewing 1997 Squires 2002). One type of development pattern that has received increasing attention by researchers and policy makers interested in fostering sustainable communities is called "sprawl." Sprawl is generally typified as low-density, haphazard development spiraling outward from urban centers (Burchell et al. The footprint of major metropolitan areas, suburbs, and small towns ultimately shapes the environmental and social conditions within our communities. Mortality prevalence primary prevention secondary prevention stroke.The way in which we develop the American landscape and its urban areas is a critical component to creating livable and sustainable cities. Future efforts should focus not only on control of known vascular risk factors but also on addressing other determinants of health in rural communities. Rural residence was associated with the rate of stroke and death even after adjustment for risk factors. ![]() ![]() Conclusions In this population-based study of over 6 million people with universal access to physician and hospital services, risk factors were more prevalent but less likely to be controlled in rural than in urban residents without prior stroke, whereas in those with prior stroke, risk factor prevalence and treatment were similar. After adjustment for sociodemographic and comorbid conditions, rural residence was associated with higher rates of stroke and all-cause mortality in both the primary prevention (adjusted hazard ratio for stroke, 1.06 95% CI, 1.04-1.09 aHR for mortality, 1.09 95% CI, 1.08-1.10) and the secondary prevention cohort (aHR for stroke, 1.11 95% CI, 1.02-1.19 aHR for mortality, 1.07 95% CI, 1.03-1.11). In the secondary prevention cohort, the prevalence and treatment of risk factors were similar in rural and urban residents. ![]() In the primary prevention cohort, rural residents were less likely than urban ones to be screened for diabetes mellitus (70.9% versus 81.3%) and hyperlipidemia (66.2% versus 78.4%) and less likely to achieve diabetes mellitus control (hemoglobin A1c ≤7% in 51.3% versus 54.3% P<0.001 for all comparisons). We then calculated sex-/age-standardized rates of stroke incidence and mortality per 1000 person-years between Januand Decemand used cause-specific hazard models to compare outcomes in rural versus urban areas adjusting for age, sex, income, ethnicity, smoking, physical activity and comorbid conditions, and accounting for the competing risk of death in the model for the occurrence of stroke incidence. We defined rural communities as those with a population size of ≤10 000 and within each of the primary and secondary prevention cohorts, compared cardiovascular risk factors and care between rural and urban areas. Methods and Results We used the CANHEART (Cardiovascular Health in Ambulatory Care Research Team) cohort, created from linked administrative databases from the province of Ontario, Canada, and divided into primary (N=6 207 032) and secondary (N=75 823) prevention cohorts based on the absence or presence of prior stroke. Background Rural residence is associated with stroke incidence and mortality, but little is known about potential rural/urban differences in ambulatory stroke care. ![]()
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