Regional differences in African Americans' high risk for stroke: the remarkable burden of stroke for Southern African Americans.
OBJECTIVE
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."
Howard
George
G
University of Alabama School of Public Health, Department of Biostatistics, Birmingham, AL 35294-0022, USA. ghoward@uab.edu
Labarthe
Darwin R
DR
Hu
Jianfang
J
Yoon
Sarah
S
Howard
Virginia J
VJ
D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D015144:Southeastern United States / Q000453:epidemiology; D020521:Stroke / Q000191:economics / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D044465:White People
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