(Stroke. 1995;26:1145-1149.)
© 1995 American Heart Association, Inc.
Articles |
The Geography of Stroke Mortality in the United States and the Concept of a Stroke Belt
From the Departments of Neurology and Preventive Medicine and Environmental Health, and the Sanders Brown Center on Aging, University of Kentucky Medical Center, Lexington, and the Neurology Service, Veterans Affairs Medical Center, Lexington, Ky (D.J.L.); and the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pa (L.H.K.).
Correspondence to Douglas J. Lanska, MD, Department of Neurology, Rm E124, Kentucky Clinic, University of Kentucky, Lexington, KY 40536-0284. E-mail djlansva@ukcc.uky.edu.
Key Words: cerebrovascular diseases • epidemiology • risk factors • geography • mortality
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Introduction |
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Since at least 1940 there has been a consistent pattern of marked geographic variation in stroke mortality rates within the United States.1 2 3 Very high rates are reported in the Southeast, and particularly the southeast coastal plain, while very low rates are reported in the Mountain census division and along the northern Atlantic coast.1 2 3 These general patterns of geographic variation have been observed for both sexes and for whites and nonwhites, although stroke rates have been consistently declining in all geographic areas of the continental United States over this interval.1 Comparable age-adjusted and race- and sex-specific data for earlier periods are not available because (1) tabulations of deaths are limited to the Death Registration Area, which did not include all of the coterminous United States until 1933,4 5 6 and (2) US mortality data were first cross-tabulated by age, race, sex, cause of death, and state in 1937. Nevertheless, age-adjusted stroke mortality rates for whites suggest that the current spatial distribution of stroke mortality was not in place in 1920; instead, the high-rate states were apparently concentrated in the northeastern United States.3 From 1920 through 1933, rates declined considerably in all states but particularly in the Northeast, shifting the distribution of excess stroke mortality southward. By 1940, rates had declined further but least in the Southeast, leaving this area with an excess of stroke mortality that has persisted for half a century.
The nonrandom distribution of stroke mortality across the United
States; the persistence of the pattern over more than five decades; the
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