Southern Blacks More Prone to Die From Stroke

WEDNESDAY, Feb. 2 (HealthDayNews) -- American black men living in southern states are at significantly higher risk of dying from stroke than black men living elsewhere in the country, researchers report.

"For a very long time, it has been known that African-Americans are at an increased risk for stroke, and it has been known that Southerners are at an increased risk for stroke," said lead researcher George Howard, professor and chairman of the Department of Biostatistics at the University of Alabama at Birmingham School of Public Health.

Altogether, Howard concluded, black Southerners have a stroke risk that is "about 20 percent greater than the increased risk of African-Americans living elsewhere."

The findings were presented Feb. 2 at the American Stroke Association''s annual International Stroke Conference in New Orleans.

In their study, Howard''s team collected data on U.S. deaths from stroke from 1997 through 2001, calculating death rates by race, age and state. They compared the findings in 10 southern states -- Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Virginia -- with those from California, Illinois, Indiana, Maryland, Michigan, New Jersey, New York, Ohio and Pennsylvania. All of these states have large black populations.

The researchers found that black males in the South were significantly more likely to die from a stroke than their counterparts living in other parts of the country. For example, in Florida, black men have a 250 percent higher risk of dying from stroke compared with whites. In comparison, this ''race gap'' in stroke risk is much narrower in New York state, where black men have risk of stroke that is 50 percent higher than that of whites, Howard said.

Lowering the stroke risk of Southerners could save hundreds of lives per year, he added.

"In 2001 there were 19,002 deaths among African-Americans for stroke," Howard said. "Of these, 9,000 were in Southern states. And about 1,500 of these deaths among African-Americans in the South should not have occurred if the increased risk in stroke for African-Americans living in the South was the same as the increased risk of African-Americans living in the North."

Since these are stroke deaths, Howard calculates there are about 5,000 extra strokes overall among blacks living in the South, compared with blacks living in other parts of the nation.

The reasons for these disparities are unknown. "It could be that whatever African-Americans living in South are doing puts them at higher stroke risk," Howard speculated, and "whatever that is, they are doing more of it than African-Americans who live elsewhere."

Howard also believes there may also be real medical reasons -- as yet unknown -- for the disparity between African-Americans and whites within geographic areas.

Other factors might be involved, too, such as urban vs. rural living, inequities in access to medical care, and poor education about stroke risks, he said. Howard also noted there are different stroke patterns within particular states.

Without knowing the real cause of the difference in stroke risk between blacks and whites, Howard advised that blacks need to be aware of risk factors for stroke and take the measures to control them.

"We need to be aggressive as possible to diagnose and treat all risk factors," Howard said. "This is such a huge problem that we really need to focus our energies on trying to reduce this disparity, using all the tools that we have. And right now the only tools we have is to work better on blood pressure control, work better on diabetes, and smoking cessation. And let''s make sure there is an awareness in the African-American community of this disparity, so at least people have the knowledge and opportunity to modify their lifestyle."

"The results underscore the need to know more about the incidence and survivability from stroke," said Wayne Rosamond, an associate professor of emergency medicine at the University of North Carolina at Chapel Hill.

Data on stroke deaths in this report includes how often the disease occurs in a population plus one''s probability of surviving a stroke if it happens, Rosamond noted. "Each is influenced by different things and therefore knowing which it is, incidence or survival or both, can give us clues about how to improve," he added.

"The South has historically been an economically underdeveloped region of the U.S.," said Elizabeth Barnett, an associate professor of biostatistics and epidemiology at the University of South Florida. "We know that residents of rural, underdeveloped areas are at greater risk for many of the risk factors regardless of race/ethnicity."

"The challenge is that doing something about these inequalities is going to require true social and economic change, to improve opportunities for success and healthy living among the most disadvantaged and vulnerable groups in our society," Barnett said.

More information

Find out more about stroke at the American Stroke Association.

SOURCES: George Howard, Dr.P.H., professor and chairman, Department of Biostatistics, University of Alabama at Birmingham School of Public Health; Wayne Rosamond, Ph.D., associate professor, emergency medicine, University of North Carolina at Chapel Hill; Elizabeth Barnett, Ph.D., associate professor, biostatistics and epidemiology, University of South Florida, Tampa; Feb. 2, 2005, presentation, American Stroke Association''s International Stroke Conference, New Orleans