title: Evaluation of social status as a contributing factor to the stroke belt region of the United States.
abstract: OBJECTIVE
  The southeastern United States has stroke mortality rates above the national average. The causes for this excess mortality are unknown; however, lower socioeconomic status (SES) is a risk factor for stroke, and the lower SES in the Southeast is a potential cause. In this report we assess the proportion of the excess stroke mortality attributable to SES.
  
  
  METHODS
  The more than 400,000 participants in the National Longitudinal Mortality Study were categorized into three regions: the coastal plain region of North Carolina, South Carolina, and Georgia ("stroke buckle"); the remainder of these states plus five other southern states ("stroke belt"); and the remainder of the United States. The stroke mortality rates were calculated with and without adjustment for SES, and the proportion of the excess mortality attributable to SES was estimated.
  
  
  RESULTS
  In persons between the ages of 35 and 54 years, stroke mortality in the stroke buckle is estimated to be more than twice that of the rest of the nation and 1.7 times greater for ages 55 to 74 years. For persons in the stroke belt, the stroke mortality was 1.3 times greater than that in the rest of the nation for the ages of 35 to 54 and 55 to 74 years. Less than 16% of this excess stroke morality was attributable to SES.
  
  
  CONCLUSIONS
  SES does not appear to be a major contributor to the excess mortality in the southeastern United States. Of additional concern is the stroke buckle region, which was shown to have stroke mortality rates substantially greater than those in the traditionally recognized stroke belt.
authors.affiliation: Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1063, USA. ghoward@phs.bgsm.edu
authors.forename: G
authors.initials: G
authors.lastname: Howard
authors.forename: R
authors.initials: R
authors.lastname: Anderson
authors.forename: N J
authors.initials: NJ
authors.lastname: Johnson
authors.forename: P
authors.initials: P
authors.lastname: Sorlie
authors.forename: G
authors.initials: G
authors.lastname: Russell
authors.forename: V J
authors.initials: VJ
authors.lastname: Howard
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012923:Social Class; D012959:Socioeconomic Factors; D015144:Southeastern United States