Even outside 'stroke belt,' African-Americans face higher mortality

African-Americans and country folk outside the so-called “stroke belt” are at higher risk for stroke death than other populations, a large new study finds.

A stroke occurs every 40 seconds somewhere in the United States, but little has been known about whether stroke mortality disparities exist outside an 11-state region in southeast United States known as the stroke belt.

Using data from the Centers for Disease Control and Prevention for the years 2000 to 2006, on more than 150 million people residing outside the stroke belt, researcher Alexander Sergeev, M.D., found stroke death to be statistically significantly higher among African-Americans than any other racial group.

The study in the journal Ethnicity and Disease also finds that stroke death is higher in rural than in urban areas.

“Urban residency was associated with a statistically significant decrease in stroke mortality among Caucasians, American Indians and Asians — but not among African-Americans,” said Sergeev, an assistant professor in social and public health at Ohio University. “This finding raises a serious concern about African-Americans being a particularly vulnerable group regarding a high risk of stroke death.”

Sergeev said the 12-percent increase in stroke mortality in rural residents, even after adjusting for major demographics, surprised him. “In other words, this increase cannot be attributed to the higher proportions of older individuals living in rural areas,” he said.

The most important message from this study, said Sergeev, is that health care professionals and policymakers must improve access to primary health care — especially for vulnerable, underserved populations.

“It is also important for health educators to educate the public about stroke risk factors and healthy lifestyle choices, as well as stroke warning signs and the importance of dialing 911 immediately at the first sign of stroke,” he said.

Leslie Ritter, Ph.D., who holds the William M. Feinberg MD Endowed Chair for Stroke Research at the University of Arizona, said the results of this study provides strong evidence for the need to expand both preventive and acute stroke services across the entire United States.

“The data emphasize the urgent need to further investigate the contribution of both traditional and nontraditional risk factors for stroke, as well as the clustering of those risk factors in all vulnerable populations, including African-Americans,” Ritter said. “While steady advances in regionalizing services to decrease rural-urban disparities in stroke care have been made in recent years, the data presented here clearly indicate that heightened efforts in this regard are essential.”