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. 2007 Sep;17(9):689-96.
doi: 10.1016/j.annepidem.2007.03.019.

Regional differences in African Americans' high risk for stroke: the remarkable burden of stroke for Southern African Americans

George Howard  1 , Darwin R Labarthe, Jianfang Hu, Sarah Yoon, Virginia J Howard
Affiliations

Regional differences in African Americans' high risk for stroke: the remarkable burden of stroke for Southern African Americans

George Howard et al. Ann Epidemiol. 2007 Sep.

Abstract

Purpose: The stroke mortality rate for African Americans aged 45 to 64 years is 3 to 4 times higher than for whites of the same age, with a decreasing black-to-white mortality ratio with increasing age. There is also a "STROKE BELT" with higher stroke mortality in the southeastern United States. This study assesses if there are also geographic variations in the magnitude of the excess stroke mortality for African Americans.

Methods: The age- and sex-specific black-to-white mortality ratio was calculated for each of 26 states with a sufficient African American population for stable estimates. The southern excess was calculated as the percentage excess of southern over nonsouthern rates.

Results: Across age and sex strata, the black-to-white stroke mortality ratio was consistently higher for southern states, with an average black-to-white stroke mortality ratio that ranged from 6% to 21% higher among southern states than in nonsouthern states.

Conclusions: The increase in stroke mortality rates for African Americans in southern states is even larger than expected. That southern states that are not part of the "STROKE BELT" (Virginia and Florida) also have an elevated black-to-white mortality ratio suggests the mechanism of higher risk for African Americans may be independent of the causes contributing to "STROKE BELT."

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Figures

Figure 1A (men) and 1B (women)
Figure 1A (men) and 1B (women)
Stroke mortality ratios (black-to-white) for non-southern (N) and southern (S) states, by age strata and sex.
Figure 2
Figure 2
Black-to-white stroke mortality ratio for men and women from New York and Florida, by age strata.
Figure 3
Figure 3
Observed stroke mortality for white men aged 65 to 74 (gray). Observed (#1, solid black line) and expected (#2 and #3) mortality rates are shown for black men aged 65 to 74. Expected rates are shown if the pattern was similar to the pattern for whites on a multiplicative or relative scale (#2: square and short dashed line) or on an additive scale (#3: triangle and long dashed line).
See this image and copyright information in PMC

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