The farther from town the lower the blood pressure: report from rural Yunnan province

Geographic Elevation, Car Driving, and Depression among Elderly Residents in Rural Areas: The Shimane CoHRE Study

Given that public transportation networks are often worse in rural areas than in urban areas, it is difficult for elderly non-drivers to access health-promoting goods, services, and resources related to mental health. Moreover, geographical location, assessed by elevation, could modify this association in a rural area. The aim of this study was to test whether the association between car driving (being a driver or not) and depression, as measured by the Zung Self-Rating Depression Scale (SDS), varied by elevation. Data were collected from a cross-sectional study conducted in the town of Ohnan located in a rural area of Japan. After excluding participants with missing data (n = 26), 876 participants were analysed in this study. After adjustment for potential confounders, being a non-driver had a significantly higher odds ratio of SDS (40+) among elderly people living at a low elevation (odds ratio = 2.17, 95% confidence interval = 1.28–3.71). However, similar findings were not observed among elderly people living at a high elevation. These results suggest that car driving importantly predicts depression in elderly people living at relatively low elevations in rural areas.

Effect of environmental and lifestyle factors on hypertension: Shimane COHRE study

Background

In recent years there has been increasing evidence of an association between residential remoteness and hypertension (HTN); however, no study has examined the effects of residential remoteness-lifestyle associations on HTN. The objective of this study was to evaluate the effects of residential remoteness, as measured by road network distance and elevation, and lifestyle associations, including access to daily products as a measure of car use, on HTN in a rural region in Japan.

Method

This is a cross-sectional population based study. We analyzed data from the Shimane COHRE study conducted from 2006 to 2009 in the rural mountainous regions of Japan. After excluding missing data, we conducted a logistic regression analysis of the data for 1,348 individuals and examined the effects of residential remoteness and lifestyle associations, including road network distance, elevation and access to daily products as a measure of car use, on the prevalence of HTN.

Principal Findings

In participants without access to car use, the odds ratios for self-reported HTN (i.e. taking antihypertensive medication) were significantly increased in those living in moderate (odds ratio (OR): 2.21, 95% confidence interval (CI): 1.19–4.08) and far (OR: 2.55, 95% CI: 1.00–6.51) road distances, whereas there were no significant associations in participants with access to car use. There were no significant associations between elevation and HTN for participants either with or without access to car transportation.

Conclusions

Our findings show that specific residential remoteness-hypertension associations vary according to access to daily products as a measure of car use in a rural mountainous area of Japan. These results advance the understanding and importance of considering residential environment, “where people live,” in establishing health policy.

Is location associated with high risk of hypertension? Shimane COHRE Study

BACKGROUND

There is growing evidence that residential environment is associated with hypertension. Recently, interest has also turned toward examining the possible influence of remoteness on hypertension. The aim of this study is to explore the effect of remoteness, the shortest path between the subject location and the population center, on hypertension prevalence in a rural region in Japan.

METHODS

We analyzed data from the Shimane COHRE Study conducted from 2006 to 2009 in rural mountainous regions of Japan. After excluding the missing data, we conducted a logistic regression analysis of the data for 1,348 individuals. Geographic information systems (GIS) were used in the network analysis. Network analysis determined the distance between subject's location and population center on road networks, and the distance was divided into tertiles: 0-26,685.8 m = close distance, 26,685.9 m-38,350.6 m = moderate distance, 38,350.7 m-68,070.1 m = far distance.

RESULTS

According to self-reported hypertension, the odds ratios for hypertension (taking antihypertensive medication or under treatment for hypertension without medication) were 1.44 (95% confidence interval (CI): 1.04-1.99) and 1.78 (95% CI: 1.29-2.46) in moderate and far distances, respectively, after adjustment for potential confounders. The odds ratios no longer remained significant after considering the measurement of blood pressure (BP) to define hypertension (taking antihypertensive medication or under treatment for hypertension without medication or BP ≥ 140/90 mm Hg for systolic BP (SBP)/diastolic BP (DBP)).

CONCLUSIONS

Our findings show that residential remoteness might be associated with a higher risk of hypertension in a rural region in Japan.