(Stroke. 1995;26:1153-1158.)
© 1995 American Heart Association, Inc.
Articles |
Is the Stroke Belt Disappearing?
An Analysis of Racial, Temporal, and Age Effects
From the Departments of Public Health Sciences (G.H., G.W.E., G.L.B., E.J.M.), Neurology (G.H., V.J.H.), Family and Community Medicine (K.P.), and Internal Medicine and Gerontology (R.A.B.), Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC.
Correspondence to Dr George Howard, Department of Public Health Sciences, Bowman Gray School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157-1063.
Background and Purpose The stroke risk among white residents of the coastal plain of North Carolina, South Carolina, and Georgia (the "Stroke Belt") has been reported to be between 1.3 and 2.0 times the national average. In this study we examined (1) whether a similar excess risk exists for blacks in this region, (2) whether this regional excess stroke risk has decreased over time, and (3) whether the regional excess risk is consistent across ages from 45 to more than 85 years.
Methods Using data from the Compressed Mortality File, we estimated the annual relative stroke mortality risk for black and white men and women in a region of 153 coastal plain counties and compared these rates to those for the remainder of the United States.
Results The relative geographic excess risk of stroke death was similar for black residents and white residents of the Stroke Belt for both men and women. Despite the decline in stroke mortality, the relative increased risk of stroke death in the region has remained constant from 1968 to 1991; however, the pattern of excess risk across age differed significantly between race/sex groups.
Conclusions These data show that the Stroke Belt continues to exist for blacks and whites and for men and women. Although the specific causes of the Stroke Belt remain unknown, the public health impact is staggering, with a greater than 40% excess risk of stroke mortality and more than 1200 excess stroke deaths annually.
Key Words: cerebrovascular disorders • geography • mortality • racial differences
This article has been cited by other articles:
 |
|
 |
|
  D. M. Bravata, S.-Y. Ho, T. P. Meehan, L. M. Brass, and J. Concato Readmission and Death After Hospitalization for Acute Ischemic Stroke: 5-Year Follow-Up in the Medicare Population Stroke, June 1, 2007; 38(6): 1899 - 1904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Kelley and K. Betsalel Travels in Stroke Country: An Ethnographic Photo Essay Journal of Contemporary Ethnography, April 1, 2005; 34(2): 170 - 179. [Abstract] [PDF]
|
|
|
|
|
|
H. J. Fullerton, J. S. Elkins, and S. C. Johnston Pediatric Stroke Belt: Geographic Variation in Stroke Mortality in US Children Stroke, July 1, 2004; 35(7): 1570 - 1573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. B. Gorelick TIA incidence and prevalence: The Stroke Belt perspective Neurology, April 27, 2004; 62(8_suppl_6): S12 - S14. [Full Text]
|
|
|
|
 |
|
 I. Hajjar and T. Kotchen Regional Variations of Blood Pressure in the United States Are Associated with Regional Variations in Dietary Intakes: The NHANES-III Data J. Nutr., January 1, 2003; 133(1): 211 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.J. Fullerton, D.M. Chetkovich, Y.W. Wu, W.S. Smith, and S.C. Johnston Deaths from stroke in US children, 1979 to 1998 Neurology, July 9, 2002; 59(1): 34 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Ayala, J. B. Croft, K. J. Greenlund, N. L. Keenan, R. S. Donehoo, A. M. Malarcher, and G. A. Mensah Sex Differences in US Mortality Rates for Stroke and Stroke Subtypes by Race/Ethnicity and Age, 1995-1998 Stroke, May 1, 2002; 33(5): 1197 - 1201. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Ayala, K. J. Greenlund, J. B. Croft, N. L. Keenan, R. S. Donehoo, W. H. Giles, S. J. Kittner, and J. S. Marks Racial/Ethnic Disparities in Mortality by Stroke Subtype in the United States, 1995-1998 Am. J. Epidemiol., December 1, 2001; 154(11): 1057 - 1063. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, L. A. Hey, and R. Laney North Carolina Stroke Prevention and Treatment Facilities Survey : Statewide Availability of Programs and Services Stroke, January 1, 2000; 31(1): 66 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. F. Gillum Stroke Mortality in Blacks : Disturbing Trends Stroke, August 1, 1999; 30(8): 1711 - 1715. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. B. Gorelick Cerebrovascular Disease in African Americans Stroke, December 1, 1998; 29(12): 2656 - 2664. [Full Text] [PDF]
|
|
|
|
|
|
D. T. Lackland, D. L. Bachman, T. D. Carter, D. L. Barker, S. Timms, and H. Kohli The Geographic Variation in Stroke Incidence in Two Areas of the Southeastern Stroke Belt : The Anderson and Pee Dee Stroke Study Stroke, October 1, 1998; 29(10): 2061 - 2068. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. B. Goldstein, L. A. Hey, and R. Laney North Carolina Stroke Prevention and Treatment Facilities Survey : rtPA Therapy for Acute Stroke Stroke, October 1, 1998; 29(10): 2069 - 2072. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Kotchen and J. M. Kotchen Regional Variations of Blood Pressure : Environment or Genes? Circulation, August 19, 1997; 96(4): 1071 - 1073. [Full Text]
|
|
|
|
|
|
C. I. Kiefe, O. D. Williams, D. E. Bild, C. E. Lewis, J. E. Hilner, and A. Oberman Regional Disparities in the Incidence of Elevated Blood Pressure Among Young Adults : The CARDIA Study Circulation, August 19, 1997; 96(4): 1082 - 1088. [Abstract] [Full Text]
|
|
|
|
|
|
L. W. Pickle, M. Mungiole, and R. F. Gillum Geographic Variation in Stroke Mortality in Blacks and Whites in the United States Stroke, August 1, 1997; 28(8): 1639 - 1647. [Abstract] [Full Text]
|
|
|
|
|
|
R. L. Sacco, E. J. Benjamin, J. P. Broderick, M. Dyken, J. D. Easton, W. M. Feinberg, L. B. Goldstein, P. B. Gorelick, G. Howard, S. J. Kittner, et al. Risk Factors Stroke, July 1, 1997; 28(7): 1507 - 1517. [Full Text]
|
|
|
|
|
|
G. Howard, R. Anderson, N. J. Johnson, P. Sorlie, G. Russell, and V. J. Howard Evaluation of Social Status as a Contributing Factor to the Stroke Belt Region of the United States Stroke, May 1, 1997; 28(5): 936 - 940. [Abstract] [Full Text]
|
|
|
|
|
|
D. J. Lanska and L. H. Kuller The Geography of Stroke Mortality in the United States and the Concept of a Stroke Belt Stroke, July 1, 1995; 26(7): 1145 - 1149. [Full Text]
|
|
|
|
|
|
G. Howard and V. J. Howard The End of the Stroke Belt? : It May Be Too Early to Declare Victory! Stroke, July 1, 1995; 26(7): 1150 - 1152. [Full Text]
|
|