Geography of Stroke Mortality: Hotspotting Areas for Targeted Interventions (P5.009) (original) (raw)
Related papers
BMC Public Health, 2011
Background: Stroke and myocardial infarction (MI) are serious public health burdens in the US. These burdens vary by geographic location with the highest mortality risks reported in the southeastern US. While these disparities have been investigated at state and county levels, little is known regarding disparities in risk at lower levels of geography, such as neighborhoods. Therefore, the objective of this study was to investigate spatial patterns of stroke and MI mortality risks in the East Tennessee Appalachian Region so as to identify neighborhoods with the highest risks. Methods: Stroke and MI mortality data for the period 1999-2007, obtained free of charge upon request from the Tennessee Department of Health, were aggregated to the census tract (neighborhood) level. Mortality risks were age-standardized by the direct method. To adjust for spatial autocorrelation, population heterogeneity, and variance instability, standardized risks were smoothed using Spatial Empirical Bayesian technique. Spatial clusters of high risks were identified using spatial scan statistics, with a discrete Poisson model adjusted for age and using a 5% scanning window. Significance testing was performed using 999 Monte Carlo permutations. Logistic models were used to investigate neighborhood level socioeconomic and demographic predictors of the identified spatial clusters.
Stagnating National Declines in Stroke Mortality Mask Widespread County-Level Increases, 2010–2016
Stroke
Background and Purpose— Recent national and state-level trends show a stalling or reversal of previously declining stroke death rates. These national trends may mask local geographic variation and changes in stroke mortality. We assessed county-level trends in stroke mortality among adults aged 35 to 64 and ≥65 years. Methods— We used data from National Vital Statistics Systems and a Bayesian multivariate space-time conditional autoregressive model to estimate age-standardized annual stroke death rates for 2010 through 2016 among middle-aged adults (35–64 years) and older adults (≥65 years) in US counties. We used log-linear regression models to estimate average annual and total percent change in stroke mortality during the period. Results— Nationally, the annual percent change in stroke mortality from 2010 to 2016 was −0.7% (95% CI, −4.2% to 3.0%) among middle-aged adults and −3.5% (95% CI, −10.7% to 4.3%) among older adults, resulting in 2016 rates of 15.0 per 100 000 and 259.8 pe...
Evaluation of Between-County Disparities in Premature Mortality Due to Stroke in the US
JAMA Network Open
IMPORTANCE Identifying the factors associated with premature stroke mortality and measuring between-county disparities may provide insight into how to reduce variations and achieve more equitable health outcomes. OBJECTIVE To examine the between-county disparities in premature stroke mortality in the US, investigate county-level factors associated with mortality, and describe differences in mortality disparities by place of death and stroke subtype. DESIGN, SETTING, AND PARTICIPANTS This retrospective cross-sectional study linked the mortality and demographic data of US counties from the Centers for Disease Control and Prevention WONDER database to county-level characteristics from multiple databases. The outcome measure was county-level age-adjusted stroke mortality among adults aged 25 to 64 years in 2637 US
Stroke, 1998
Carolina and the southeastern United States have maintained the highest stroke mortality in the country. The Anderson and Pee Dee Stroke Study is an assessment of cerebrovascular disease incidence in 2 geographically defined communities in the stroke belt. Methods-Strokes were identified in the Anderson and Pee Dee areas of South Carolina. All hospitalized and out-of-hospital deaths occurring during 1990 among the residents of these 2 areas were included. Strokes were classified by an independent panel of neurologists using a standard protocol that included specific criteria for stroke and subtypes. Results-The overall age-adjusted stroke incidence rates (per 100 000 population) were significantly higher in the Pee Dee population (293.1) compared with Anderson (211.2). The geographic differences were more dramatic in the younger age groups of 35 to 64 years. Likewise, incidence rates for blacks were nearly twice the rates for whites. The rates in the Pee Dee were higher than the rates from other studies in the United States and other parts of the world. Although the stroke subtypes did not vary between the 2 regions, race-sex differences were identified. Conclusions-High stroke incidence and disease rates persist for all 4 race-sex groups in the Southeast and reflect similar risks as mortality rates. However, geographic variability in stroke rates suggests that the pattern of disease in the region is not so much a "belt" of increased stroke in contiguous areas but rather more a "necklace" of different levels of risk. These results should be useful in the identification of factors associated with this geographic enigma.
Estimated 10-year stroke risk by region and race in the United States
Annals of Neurology, 2008
Objective-African-Americans under age 75 have over twice the risk of stroke death than whites in the United States. Regardless of race, stroke death is ~50% higher in the "Stroke Belt" and "Stroke Buckle" states of the Southeastern United States. We assessed geographic and racial differences in estimated 10-year stroke risk.
Neuroepidemiology, 2003
Purpose: To provide a descriptive analysis of the stroke features in a population of patients from a large urban hospital within the 'stroke belt', with the intention of stimulating interest in creating similar comprehensive databases across the country; the differential population features that may contribute to the increased incidence of ischemic and hemorrhagic stroke within the 'stroke belt' can thus be better studied and understood. Background: Strokes account for approximately 5-10% of all deaths in the western world. Within a geographically nondescript region in the Southern United States known as the 'stroke belt', however, the incidence of stroke is 1.5-2 times greater than in other regions of the country. Despite the relatively high incidence of stroke within the 'stroke belt', very little information is available regarding the differential population features that distinguish stroke patients within this region from those in other parts of the country. Design/Methods: During the period