Regional differences in diabetes as a possible contributor to the geographic disparity in stroke mortality: the REasons for Geographic And Racial Differences in Stroke Study.
OBJECTIVE
Diabetes and hypertension impart approximately the same increased relative risk for stroke, although hypertension has a larger population-attributable risk because of its higher population prevalence. With a growing epidemic of obesity and associated increasing prevalence of diabetes that disproportionately impacts the southeastern Stroke Belt states, any potential contribution of diabetes to the geographic disparity in stroke mortality will only increase.


METHODS
Racial and geographic differences in diabetes prevalence and diabetes awareness, treatment, and control were assessed in the REasons for Geographic And Racial Differences in Stroke study, a national population-based cohort of black and white participants older than 45 years of age. At the time of this report, 21 959 had been enrolled.


RESULTS
The odds of diabetes were significantly increased in both white and black residents of the stroke buckle (OR, 1.26; [1.10, 1.44]; OR, 1.45 [1.26, 1.66], respectively) and Stroke Belt (OR, 1.22; [1.09, 1.36]; OR, 1.13 [1.02, 1.26]) compared to the rest of the United States. In the buckle, regional differences were not fully mediated and remained significant when controlling for socioeconomic status and risk factors. Addition of hypertension to the models did not reduce the magnitude of the associations. There were no significant differences by region with regard to awareness, treatment, or control for either race.


CONCLUSIONS
These analyses support a possible role of regional variation in the prevalence of diabetes as, in part, an explanation for the regional variation in stroke mortality but fail to support the potential for a contribution of regional differences in diabetes management.
Voeks
Jenifer H
JH
Departments of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. jvoeks@uab.edu
McClure
Leslie A
LA
Go
Rodney C
RC
Prineas
Ronald J
RJ
Cushman
Mary
M
Kissela
Brett M
BM
Roseman
Jeffrey M
JM
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology / Q000706:statistics & numerical data; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology; D005260:Female; D005843:Geography / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015144:Southeastern United States / Q000453:epidemiology / Q000208:ethnology; D020521:Stroke / Q000208:ethnology / Q000401:mortality* / Q000503:physiopathology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data; D001741:Black or African American