title: Effect of environmental and lifestyle factors on hypertension: Shimane COHRE study.
abstract: 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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Center for Community-Based Health Research and Education (COHRE), Organization for the Promotion of Project Research, Shimane University, Izumo, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Hamano
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Kimura
authors.forename: Miwako
authors.initials: M
authors.lastname: Takeda
authors.forename: Masayuki
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Minoru
authors.initials: M
authors.lastname: Isomura
authors.forename: Toru
authors.initials: T
authors.lastname: Nabika
authors.forename: Kuninori
authors.initials: K
authors.lastname: Shiwaku
mesh_terms: D001336:Automobiles; D004777:Environment; D005260:Female; D005843:Geography; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007564:Japan / Q000453:epidemiology; D008019:Life Style; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors