By Wayne Kuznar
New Orleans—Black Americans living in the south have an especially high rate of stroke mortality, a rate that is even greater than that predicted by the combined increased risk of being a southerner and being black, said George Howard, DrPH, chair, Department of Biostatistics, University of Alabama at Birmingham, at the American Stroke Association’s International Stroke Conference 2005.
It is known that in the United States, black Americans are at a greater risk of dying from stroke than whites, and the death rate is greater among those living in the south than among those living elsewhere. However, the new findings show that, “for African Americans living in the south, regardless of gender, the observed risk is 18% to 20% above that for the 2 added together,” said Dr Howard.
Stroke death data were examined from 1997 to 2001 and were calculated by race, age, and state. Findings were compared in the “stroke belt” states (ie, Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee), plus Florida and Virginia, with nonsouthern states with large populations of black Americans (ie, California, Illinois, Indiana, Maryland, Michigan, New Jersey, New York, Ohio, and Pennsylvania).
At all ages, a clustering of higher mortality rates was observed among blacks compared with whites in the southern states, and these rates were substantially greater than the mortality ratios in the nonsouthern states.
The average stroke death rate for white men aged 55 to 64 years living in the south was 0.49 per 1000 compared with 0.38 for white men living elsewhere, or a 29% increased stroke mortality for white men living in the south.
In contrast, the stroke rate for black men in the south was 1.59 per 1000 compared with 1.05 for blacks living elsewhere, for a total of 51% increase in stroke mortality for those living in the south. That is nearly twice the risk for blacks compared with whites living in the south.
Dr Howard also found that factors other than hypertension contribute to the excess stroke mortality in the “stroke belt.” This conclusion is drawn from a national population-based cohort study of 11,606 whites and blacks >45 years of age.
In the study, awareness of hypertension was greater for black Americans (92.8%) than for whites (89.2%), and there were no regional differences in awareness. Treatment of hypertension was also significantly greater among blacks compared with whites (91.0% vs 86.7%), with no regional differences in treatment rates. Control of hypertension, however, was substantially lower in blacks compared with whites (61.7% vs 70.1%). But southerners were more likely than nonsoutherners to have their hypertension controlled (67.8% vs 64.2%).
“This racial disparity in control is a promising area for interventions to reduce the excess stroke mortality among African Americans,” said Dr Howard. “The lack of regional differences in awareness, treatment, and control implies that factors other than hypertension may be contributing to the excess stroke mortality in the stroke belt.”