From the Department of Biometry and Epidemiology (D.T.L.; D.L.Barker) and
the Department of Neurology (D.L.Bachman, T.D.C., S.T., H.K.), Medical
University of South Carolina, Charleston, SC.
Correspondence to Daniel T. Lackland, DrPH, Department of Biometry and Epidemiology, Medical University of South Carolina, Charleston, SC 29425-2203. E-mail lackland{at}musc.edu
Background and Purpose—South
Carolina and the southeastern United States have maintained the highest
stroke mortality in the country. The Anderson and Pee Dee Stroke Study
is an assessment of cerebrovascular disease incidence in 2
geographically defined communities in the stroke belt.
Methods—Strokes were identified in the Anderson and Pee Dee areas
of South Carolina. All hospitalized and out-of-hospital deaths
occurring during 1990 among the residents of these 2 areas were
included. Strokes were classified by an independent panel of
neurologists using a standard protocol that included specific criteria
for stroke and subtypes.
Results—The overall age-adjusted stroke incidence rates (per
100 000 population) were significantly higher in the Pee Dee
population (293.1) compared with Anderson (211.2). The geographic
differences were more dramatic in the younger age groups of 35 to 64
years. Likewise, incidence rates for blacks were nearly twice
the rates for whites. The rates in the Pee Dee were higher than the
rates from other studies in the United States and other parts of the
world. Although the stroke subtypes did not vary between the 2 regions,
race-sex differences were identified.
Conclusions—High stroke incidence and disease rates persist for
all 4 race-sex groups in the Southeast and reflect similar risks as
mortality rates. However, geographic variability in stroke rates
suggests that the pattern of disease in the region is not so much a
"belt" of increased stroke in contiguous areas but rather more a
"necklace" of different levels of risk. These results should be
useful in the identification of factors associated with this geographic
enigma.
© 1998 American Heart Association, Inc.
Original Contributions
The Geographic Variation in Stroke Incidence in Two Areas of the Southeastern Stroke Belt
The Anderson and Pee Dee Stroke Study
Key Words: blacks • cerebrovascular disorders • epidemiology • geography • incidence
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