title: Is the stroke belt disappearing? An analysis of racial, temporal, and age effects.
abstract: OBJECTIVE
  The stroke risk among white residents of the coastal plain of North Carolina, South Carolina, and Georgia (the "Stroke Belt") has been reported to be between 1.3 and 2.0 times the national average. In this study we examined (1) whether a similar excess risk exists for blacks in this region, (2) whether this regional excess stroke risk has decreased over time, and (3) whether the regional excess risk is consistent across ages from 45 to more than 85 years.
  
  
  METHODS
  Using data from the Compressed Mortality File, we estimated the annual relative stroke mortality risk for black and white men and women in a region of 153 coastal plain counties and compared these rates to those for the remainder of the United States.
  
  
  RESULTS
  The relative geographic excess risk of stroke death was similar for black residents and white residents of the Stroke Belt for both men and women. Despite the decline in stroke mortality, the relative increased risk of stroke death in the region has remained constant from 1968 to 1991; however, the pattern of excess risk across age differed significantly between race/sex groups.
  
  
  CONCLUSIONS
  These data show that the Stroke Belt continues to exist for blacks and whites and for men and women. Although the specific causes of the Stroke Belt remain unknown, the public health impact is staggering, with a greater than 40% excess risk of stroke mortality and more than 1200 excess stroke deaths annually.
authors.affiliation: Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27157-1063, USA.
authors.forename: G
authors.initials: G
authors.lastname: Howard
authors.forename: G W
authors.initials: GW
authors.lastname: Evans
authors.forename: K
authors.initials: K
authors.lastname: Pearce
authors.forename: V J
authors.initials: VJ
authors.lastname: Howard
authors.forename: R A
authors.initials: RA
authors.lastname: Bell
authors.forename: E J
authors.initials: EJ
authors.lastname: Mayer
authors.forename: G L
authors.initials: GL
authors.lastname: Burke
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D012307:Risk Factors; D012737:Sex Factors; D013022:South Carolina / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American