NEUROLOGY 2009;73:1858-1865
© 2009 American Academy of Neurology
Birth and adult residence in the Stroke Belt independently predict stroke mortality
M. Maria Glymour, ScD,
Anna Kosheleva, MS and
Bernadette Boden-Albala, PhD
From the Department of Society, Human Development, and Health (M.M.G., A.K.), Harvard School of Public Health, Boston, MA; and Department of Neurology, College of Physicians and Surgeons (B.B.-A.), and Department of Sociomedical Science, Mailman School of Public Health (B.B.-A.), Columbia University, NY.
Address correspondence and reprint requests to Dr. M. Maria Glymour, 677 Huntington Avenue, Kresge 617, Boston, MA 02115; mglymour{at}hsph.harvard.edu
Background: Understanding how the timing of exposure to the US Stroke Belt (SB) influences stroke risk may illuminate mechanisms underlying the SB phenomenon and factors influencing population stroke rates.
Methods: Stroke mortality rates for United States–born black and white people aged 30–80 years were calculated for 1980, 1990, and 2000 for strata defined by birth state, state of adult residence, race, sex, and birth year. Four SB exposure categories were defined: born in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) and lived in the SB at adulthood; non-SB born but SB adult residence; SB-born but adult residence outside the SB; and did not live in the SB at birth or in adulthood (reference group). We estimated age-, sex-, and race-adjusted odds ratios for stroke mortality associated with timing of SB exposure.
Results: Elevated stroke mortality was associated with both SB birth and, independently, SB adult residence, with the highest risk among those who lived in the SB at birth and adulthood. Compared to those living outside the SB at birth and adulthood, odds ratios for SB residence at birth and adulthood for black subjects were 1.55 (95% confidence interval 1.28, 1.88) in 1980, 1.47 (1.31, 1.65) in 1990, and 1.34 (1.22, 1.48) in 2000. Comparable odds ratios for white subjects were 1.45 (95% confidence interval 1.33, 1.58), 1.29 (1.21, 1.37), and 1.34 (1.25, 1.44). Patterns were similar for every race, sex, and age subgroup examined.
Conclusion: Stroke Belt birth and adult residence appear to make independent contributions to stroke mortality risk.
Abbreviations: CI = confidence interval; SB = Stroke Belt.
Supported by a pilot project grant from the Harvard Program on Global Demography and Aging, which is supported by the National Institute on Aging.
Analyses are based on data from the National Center for Health Statistics (NCHS), but NCHS is not responsible for any analyses, interpretations, or conclusions presented here.
Disclosure: Author disclosures are provided at the end of the article.
Received April 7, 2008. Accepted in final form September 15, 2009.
