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(Stroke. 1995;26:1150-1152.)
© 1995 American Heart Association, Inc.

Articles

The End of the Stroke Belt?

It May Be Too Early to Declare Victory!

George Howard, DrPH Virginia J. Howard, MSPH

From the Departments of Public Health Sciences (G.H.) and Neurology (G.H., V.J.H.), Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC.

Correspondence to George Howard, DrPH, Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Medical Center Blvd, Winston-Salem, NC. E-mail howard@phs.bgsm.wfu.edu.

Key Words: epidemiology • geography • cerebrovascular disorders • mortality

	Introduction

 
Although there is little debate about whether there has been excess stroke mortality in the southeastern United States,^{1 2 3 4 5 6 7 8 9 10} there is a growing healthy scientific debate about whether this "Stroke Belt" is dissipating or persisting. With both scientific involvement as cerebrovascular epidemiologists and personal involvement as long-term residents, we greet news of the potential dissipation of the Stroke Belt with great enthusiasm. However, describing the Stroke Belt reminds one of the proverb of blind men probing different parts of the elephant and trying to describe the total animal. Which part of the beast one gropes changes the perception of the animal. Similarly, different methodological approaches to describing the Stroke Belt and temporal changes in this region greatly influence interpretation. Not that different approaches are "wrong"; rather, differences must be appreciated to understand the nature of the beast. As such, the strengths and weaknesses of different methodological approaches should be reviewed.

	A Review of the Case for the Dissipation of the Stroke Belt

 
In this issue of Stroke Lanska and Peterson¹ report an analysis of state mortality rates and conclude that "the long-standing excess of stroke mortality in the southeastern United States, and particularly the dense concentration of excess stroke mortality along the Atlantic coastal plain, is beginning to dissipate." The authors also note that the rate of decline in stroke mortality rates has been highest in the South and that the magnitude of the difference between high- and low-rate areas has become much smaller. That there is a "shifting" of high stroke rates from the Piedmont region of the Southeast to the Mississippi . . . [Full Text of this Article]

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