This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lanska, D. J. Articles by Peterson, P. M. Search for Related Content PubMed PubMed Citation Articles by Lanska, D. J. Articles by Peterson, P. M.

(Stroke. 1996;27:1055-1059.)
© 1996 American Heart Association, Inc.

Articles

Comparison of Additive and Multiplicative Models of Regional Variation in the Decline of Stroke Mortality in the United States

Douglas J. Lanska, MD, MS Patrick M. Peterson, PhD

From the Departments of Neurology, Preventive Medicine and Environmental Health, and Statistics, and the Sanders Brown Center on Aging, University of Kentucky Medical Center, Lexington, and the Neurology Service, Veterans Affairs Medical Center, Lexington, Ky.

Correspondence to Douglas J. Lanska, MD, Department of Neurology, Rm L412, Kentucky Clinic, University of Kentucky, Lexington, KY 40536-0284.

Background and Purpose Although previous studies have shown that geographic variation in the decline of stroke mortality rates may be an important contributor to the changing geographic distribution of stroke mortality in the United States, some concern has been raised that this phenomenon may be model dependent. This study examines the geographic variation in the decline of stroke mortality rates in the United States with the use of both additive and multiplicative models.

Methods National Center for Health Statistics and Bureau of the Census data were used to assess regional-level temporal trends of underlying-cause stroke mortality rates in the United States for 1979 through 1989. Both additive and multiplicative models were fit to the data.

Results Underlying-cause stroke mortality rates have declined fairly steadily in all regions of the United States and for all race-sex groups, although there was significant regional variation in the rate of decline during the period 1979 through 1989. The South, which initially had the highest rates, had the most rapid decline for all race-sex groups when either additive or multiplicative models were used.

Conclusions From 1979 through 1989 there was significant geographic variation in the rate of decline of stroke mortality rates, with the most rapid rates of decline in the South. As a result, there has been a decrease in interregional variation in stroke mortality rates.

Key Words: cerebrovascular disorders • epidemiology • mortality • risk factors

This article has been cited by other articles:

				A. K. Jha, S. M. Wright, and J. B. Perlin Performance Measures, Vaccinations, and Pneumonia Rates Among High-Risk Patients in Veterans Administration Health Care Am J Public Health, December 1, 2007; 97(12): 2167 - 2172. [Abstract] [Full Text] [PDF]

				A. K. Jha, M. G. Shlipak, W. Hosmer, C. D. Frances, and W. S. Browner Racial Differences in Mortality Among Men Hospitalized in the Veterans Affairs Health Care System JAMA, January 17, 2001; 285(3): 297 - 303. [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]

				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]