Geographic variation in stroke mortality in blacks and whites in the United States

Background and Purpose: We sought to determine whether the 'Stroke Belt' has continued to shift and to assess variation in geographic patterns by age, sex, and race. Methods: Mortality data for Health Service Areas for 1988 to 1992 were used for analyses of geographic mortality patterns for stroke by race, sex, and age (50, 70, and 90 years). Results: In 1988 to 1992, considerable geographic variation in stroke mortality was demonstrated for each sex/race group. In black and white women and men, previously described high mortality in the southeastern United States persisted. Mortality rates were generally higher in the South than in the North and in the East than in the West. Compared with data from 1962 to 1988, there was a continuation of the previously described westward shift of high-rate areas to the Mississippi River valley, a trend more marked at age 50 years than at 70 or 90 years. Although rates in the Pacific region were low overall, a surprising area of high rates was seen in southern California among women at all three ages examined. Conclusions: In whites, rapid declines in stroke mortality in the Southeast have left West South Central stares with relatively high mortality rates; this trend may continue as younger cohorts age. However, rates in the Southeast also remain high, especially for blacks.