Racial and rural-urban disparities in stroke mortality outside the Stroke Belt

Abstract

Objectives: Stroke disparities in relation to the Stroke Belt have been studied extensively, but little is known about stroke mortality disparities outside the Stroke Belt. We examined the hypothesis that racial and rural-urban stroke disparities exist outside the Stroke Belt.

Design, setting, participants: A county-based population study of stroke mortality in adults, aged -25 years, for a seven-year period (2000-2006) was conducted in the non-Stroke Belt states. Data on stroke deaths were obtained from the Centers for Disease Control and Prevention, National Center for Health Statistics. Relative risks (RR) were estimated by multivariable Poisson regression, adjusting for known confounders.

Main outcome measure: Stroke death rates.

Results: In the non-Stroke Belt states, African Americans had 1.44 times higher stroke death rates than Caucasians, 2.14 times higher than Asians/Pacific Islanders, and 1.56 times higher than American Indians (adjusted RR=1.44, P<.001; adjusted RR=2.14, P<.001; and, adjusted RR=1.56, P<.001, respectively). After adjusting for race, sex, and age, residents of rural counties outside the Stroke Belt still had a statistically significant 12% increase in stroke mortality compared to urban counties (adjusted RR=1.12, P<.001). Female sex and older age were also associated with higher stroke mortality.

Conclusions: The present study revealed that racial and rural-urban disparities in stroke mortality exist in populations residing outside the Stroke Belt. Stroke mortality in the non-Stroke Belt states is disproportionately higher in African Americans and in rural area residents. African Americans are the only racial group in which urban residency is not associated with a decrease in stroke mortality.