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(Stroke. 2003;34:1602.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—Prenatal Influences on Stroke Mortality in England and Wales

Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, Center for Clinical Health Policy Research, Duke University and VA Medical Center, Durham, North Carolina

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Genetic and environmental factors may interact in complex ways to alter an individual’s susceptibility to a variety of diseases, including stroke. Analysis of epidemiological data in the present study shows that people who were born in areas of high stroke mortality in England and Wales were at higher risk of stroke-related mortality than those migrating into these localities.¹ The same may be true in the United States. South Carolina has one of the highest stroke mortality rates in the southeastern "stroke belt" region of the country,² the existence of which is not fully understood.³ Those born and residing in South Carolina have higher stroke mortality rates than those who were born outside of the stroke belt and then moved to the state.⁴ Those residing in South Carolina who were born in other areas of the stroke belt have intermediate rates.

Why would place of birth affect stroke, a disease occurring decades later? The present study also finds that stroke mortality rates among adults in England and Wales are higher among persons who had lower birth weights. By analogy to their present results, the authors hypothesize that lower birth weights might at least partially underlie the US stroke belt as well. An abstract presented at the 2003 International Stroke Conference supports this view.⁵ This study compared a group of South Carolina Medicaid Beneficiaries having stroke under 50 years of age to population controls. The odds of stroke were more than double for those with birth weights <2500 g as compared with . . . [Full Text of this Article]