title: Pediatric Stroke Belt: geographic variation in stroke mortality in US children.
abstract: OBJECTIVE
  Numerous studies have demonstrated higher stroke mortality rates in adults residing in the Southeastern United States (the "Stroke Belt"). If the Stroke Belt is solely caused by regional differences in atherosclerotic stroke risk factors, it should not apply to children.
  
  
  METHODS
  For the years 1979 to 1998, we determined rates of death from stroke in children <20 years of age based on death certificates, and compared age-adjusted stroke mortality rates in 11 Stroke Belt states versus other US states. For comparison, the same methods were applied to adults.
  
  
  RESULTS
  Children in Stroke Belt states have an increased risk of death from stroke compared with children in other states (relative risk [RR], 1.21; 95% CI, 1.12 to 1.29). The greater risk in Stroke Belt states was apparent for ischemic and hemorrhagic stroke, for all age groups and both sexes, and persisted after adjustment for ethnicity. The geographic disparity in children was similar in magnitude to that in adults.
  
  
  CONCLUSIONS
  Similar to adults, children in Stroke Belt states have a higher risk of death from stroke than children in other US states. Stroke risk factors that are applicable to both children and adults should be considered in attempts to explain this geographic variation.
authors.affiliation: Department of Neurology, University of California, San Francisco, San Francisco, Calif 94143-0114, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Elkins
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015144:Southeastern United States / Q000453:epidemiology; D020521:Stroke / Q000208:ethnology / Q000401:mortality*; D014481:United States / Q000453:epidemiology