Showing papers by "Claudia S. Moy published in 2008"

Estimated 10-year stroke risk by region and race in the United States: geographic and racial differences in stroke risk.

Abstract: Stroke is the third leading cause of death in the United States, accounting for 1 of every 16 deaths in 2004 1. Residents of the Southeastern United States (“stroke belt”) have approximately 50% higher rates of stroke mortality than the remainder of the United States 2–4. These geographic differences have existed since at least 1940 2, with excess deaths demonstrated for men, women, whites and African-Americans 4. The cause of the excess stroke mortality in the stroke belt is unknown 5, 6. Differences in stroke incidence may contribute to the excess mortality, but little national data on regional differences in incidence are available to address this hypothesis. For white men and women, data from the first National Health and Nutrition Examination Survey (NHANES I) suggested that stroke incidence was higher in the Southeast than the Northeast, but the pattern was inconsistent between the Southeast and other regions 7. In addition, while the stroke belt is at least as pronounced for blacks as for whites 8–10 and the incidence of stroke was higher among blacks 11–13 in some studies, in NHANES I regional differences in stroke incidence among African-Americans were not as striking as those among whites 7. Lower rates of stroke hospitalization in the stroke belt could also explain underlying differences in mortality; however among Medicare recipients, those in Southeastern states were more likely to be hospitalized for stroke than in other regions 14. Another potential cause of the stroke belt is differences in case fatality by region; however little information is available to support this hypothesis 15. Similarly, differential case fatality according to race has not been clearly demonstrated 12, 13, 16. Hence, the available data suggest that geographic and racial variations in stroke mortality relate to differences in incidence, not case fatality. If this is the case, then disparities in stroke risk factors may underlie observed differences in stroke mortality. The Framingham Heart Study investigators identified nine risk factors for stroke: age, sex, systolic blood pressure, antihypertensive therapy, diabetes, current smoking, prior cardiovascular disease, atrial fibrillation, and left ventricular hypertrophy 17. The Framingham Stroke Risk Score (FSRS), developed and validated in a primarily white population, predicts the 10-year probability of stroke based on these nine risk factors. To address the role of stroke risk factors on regional and racial differences in stroke mortality, we studied geographic and racial differences in the FSRS in a national cohort.