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(Stroke. 1995;26:1999-2003.)
© 1995 American Heart Association, Inc.

Articles

Geographic Variation in Reporting of Stroke Deaths to Underlying or Contributing Causes in the United States

Douglas J. Lanska, MD, MS Patrick M. Peterson, PhD

From the Departments of Neurology (D.J.L., P.M.P), Preventive Medicine and Environmental Health (D.J.L.), and Statistics (P.M.P.), and the Sanders Brown Center on Aging (D.J.L.), University of Kentucky Medical Center; and the Neurology Service (D.J.L.), Veterans Affairs Medical Center, Lexington, KY.

Correspondence to Douglas J. Lanska, MD, Department of Neurology, Rm E124, Kentucky Clinic, University of Kentucky, Lexington, KY 40536-0284.

Background and Purpose This study examines the geographic variation in the reporting of deaths with stroke as the underlying or contributing cause in the United States.

Methods Data from the National Center for Health Statistics and Bureau of the Census were used to map the geographic distribution of race- and race/sex-specific, underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates in the United States by state for 1979 through 1981.

Results Underlying-, contributing-, and multiple-cause age-adjusted stroke mortality rates were significantly clustered for both whites and blacks. However, the spatial distributions of underlying- and contributing-cause rates differed; there was no association between underlying- and contributing-cause rates for either racial group or for the various race/sex groups. There was no association between nonstroke mortality and stroke mortality rates. There was also very little spatial variation and no spatial clustering of the median number of contributing causes reported.

Conclusions The overall large-scale spatial distribution of resident underlying-cause stroke mortality rates cannot be explained by geographic variation in the selection of the underlying cause of death from among all causes reported on the death certificate, by different area-dependent tendencies for mortality generally, or by different tendencies to consider stroke as the cause of death when death occurs. Geographic variation in contributing-cause rates is not explained by variation in tendency to report contributing causes of death.

Key Words: epidemiology • geography • mortality • risk factors

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