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(Stroke. 2006;37:1975.)
© 2006 American Heart Association, Inc.

Original Contributions

Geographic Variations in Stroke Incidence and Mortality Among Older Populations in Four US Communities

Aiman El-Saed, MD, PhD, MPH; Lewis H. Kuller, MD, DrPH; Anne B. Newman, MD, MPH; Oscar Lopez, MD; Joseph Costantino, DrPH; Kathleen McTigue, MD, MS, MPH; Mary Cushman, MD, MSc Richard Kronmal, PhD

From the Department of Epidemiology (A.E., L.H.K., A.B.N.), University of Pittsburgh, Pa; the Department of Neurology (O.L), University of Pittsburgh, Pa; the Department of Biostatistics (J.C.), University of Pittsburgh, Pa; the Department of General Medicine (K.M.), University of Pittsburgh, Pa; the Department of Medicine (M.C.), University of Vermont, Colchester, Vt; and the Department of Biostatistics (R.K.), University of Washington, Seattle, Wash.

Correspondence to Aiman El-Saed, MD, PhD, MPH, Department of Epidemiology, University of Pittsburgh, 130 N Bellefield Ave, Rm 405, Pittsburgh, PA 15213. E-mail amest30{at}pitt.edu

Background and Purpose— Stroke is a leading cause of death and disability in the US. There is limited data on geographic variations in stroke incidence among older US populations who experience the majority of stroke burden. The purpose of this study was to compare stroke incidence and mortality rates in 4 US communities.

Methods— Participants in the Cardiovascular Health Study (CHS) who had no history of stroke at baseline (n=5639) were followed for 10 or 7 years in predominantly white (n=5002) and black (n=637) participants, respectively. Incident stroke was validated by a stroke adjudication committee after ascertainment at annual visits, interim telephone contacts, and review of Medicare hospitalization data.

Results— The 2000 US population age and sex standardized total stroke incidence rate for all CHS participants was 17.7 per 1000 person-years (95% CI: 15.9, 19.5). The rate was significantly lower in Allegheny County, Pennsylvania 9.6/1000 person-years (95% CI: 7.7, 11.5) than Forsyth County, North Carolina 19.2/1000 person-years (95% CI: 15.6, 22.8), Sacramento County, California 20.7/1000 person-years (95% CI: 16.9, 24.5), and Washington County, Maryland 19.8/1000 person-years (95% CI: 16.1, 23.5). The lower stroke incidence rate in Allegheny County was consistent in gender, race, and age groups. Though not statistically significant, stroke mortality was also lower in Allegheny County than other 3 sites. The 1-month case fatality rate was similar in the 4 sites for all strokes, and by stroke types.

Conclusions— Understanding geographic variations in stroke incidence may be an important step in improving preventive practices of stroke.

Key Words: epidemiology • incidence • geography • mortality • stroke

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Factors Associated With Geographic Variations in Stroke Incidence Among Older Populations in Four US Communities

Aiman El-Saed, Lewis H. Kuller, Anne B. Newman, Oscar Lopez, Joseph Costantino, Kathleen McTigue, Mary Cushman, and Richard Kronmal
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