The Stroke Belt is a region of higher stroke mortality in the Southeastern United States that has persisted since at least 1940. Two decades ago (1999), potential contributors to this disparity were reviewed. This report, published in Stroke, serves to describe the subsequent progress in understanding the magnitude and contributors to the Stroke Belt.
Dr. George Howard, Department of Biostatistics and Dr. Virginia Howard, Department of Epidemiology, at the University of Alabama at Birmingham School of Public Health collaborated on this study. They have received funding from the National Institute of Neurological Disorders and Stroke / National Institutes of Health (NINDS/NIH) for REGARDS (Reasons for Geographic and Racial Differences in Stroke) and other studies.
The Stroke Belt is defined based on higher stroke mortality from all strokes in the Southeastern United States compared with other regions. The data suggest that contributors to the Stroke Belt may include larger proportion of blacks and residents with higher prevalence of traditional stroke risk factors, higher prevalence of inflammation and infection, and lower socioeconomic status. Environmental exposures and lifestyle choices perhaps play a lesser role.
Over the past 20 years, there have been substantial advancements in understanding some of the potential contributors to the higher stroke mortality in the Stroke Belt. The reasons for an apparent larger impact of the Stroke Belt for African Americans than for whites remains a mystery. Additional investigations should consider access to care and quality of care that could contribute to the Stroke Belt through a higher case-fatality in the region. While substantial progress has been made to advance the understanding of the contributors to the Stroke Belt, much work remains to better understand this disparity.Friday Letter Submission, Publish on March 06