title: Stroke mortality disparities in the population of the Appalachian Mountain region.
abstract: OBJECTIVE
  Racial and rural-urban differences in stroke were previously reported in demographically and socioeconomically heterogeneous populations. However, it is not clear whether they exist in more homogeneous populations. Compared to the rest of the United States, the Appalachian region is highly rural and more homogeneous, with a predominantly White and socioeconomically disadvantaged population. The goal of our study was to investigate whether racial disparities in stroke mortality exist among the Appalachian population.
  
  
  METHODS
  Patterns of stroke mortality for a seven-year period (2000-2006) were investigated in the Appalachian adult population of > or = 25 years. Data on stroke deaths were obtained from the Centers for Disease Control and Prevention, National Center for Health Statistics. Multivariable Poisson regression models were used to estimate adjusted relative risks (RR), adjusting for confounding factors.
  
  
  METHODS
  Stroke death rates.
  
  
  RESULTS
  Stroke mortality in Appalachia was 20.5% higher than outside Appalachia (96.67 and 80.25 per 100,000 person-years, P < .001). Stroke mortality was statistically significantly higher in African Americans than in other racial groups: Caucasians (adjusted RR = 1.428, P < .001), Asians (adjusted RR = 2.821, P < .001), and Native American Indians (adjusted RR = 3.571, P < 0.001). Rural-urban stroke mortality disparities were statistically significant outside Appalachia but not within Appalachia.
  
  
  CONCLUSIONS
  Racial disparities in stroke mortality exist in the Appalachian region. Further studies are warranted to investigate the rationale for possible health policy interventions and socioeconomic measures.
authors.affiliation: Department of Social and Public Health, Ohio University, Grover Center W343, Athens, OH 45701, USA. sergeev@ohio.edu
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Sergeev
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001061:Appalachian Region / Q000453:epidemiology; D044466:Asian People / Q000706:statistics & numerical data*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016012:Poisson Distribution; D012424:Rural Population / Q000706:statistics & numerical data; D020521:Stroke / Q000208:ethnology / Q000401:mortality*; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*