The Neighborhood Where You Live Is a Risk Factor for Stroke

Abstract

Background-The excess stroke mortality in the southeastern states of the United States (stroke-belt states) is well known; however, the factors associated with this pattern have not been fully elucidated. We measured the contribution of several demographic factors by analyzing stroke mortality data (2005)(2006)(2007)(2008)(2009) at the census block group (BG) level in the state of Arkansas. Methods and Results-Census BGs were used as proxies for neighborhoods. BGs were stratified using 5 census measures: poverty (percent of population below federal poverty level), population density (population per square mile), education (percent of population aged >25 years who did not graduate from high school), population mobility (percent of population who resided at the same address 1 year ago), and the percent of non-Hispanic blacks (percent of population that is black). Generalized additive models were used to estimate the variation in stroke mortality among BGs and to assess the impact of different demographic variables. From 2005 to 2009, there were 8930 stroke deaths in Arkansas. There was considerable variation in the relative risk even between adjacent BGs within a single county. The geographically weighted regression analyses indicated that 4.5% to 9% of deviance in stroke mortality among BGs could be explained by poverty, education, population density, and population mobility. Race/ethnicity (non-Hispanic blacks) explains <2% of the deviance in stroke mortality among BGs. Conclusions-Our study shows that primordial risk factors such as poverty and education drive disparities in stroke mortality among neighborhoods in Arkansas.

Historical Differences in School Term Length and Measured Blood Pressure: Contributions to Persistent Racial Disparities among US-Born Adults

“…Recent studies have started to stress the role of environmental and biological primordial risk factors for adult cardiovascular health. [49,50] Our study extends previous research on primordial prevention of cardiovascular disease by stressing the role of educational policy and school quality. Longer school years, and other investments in the determinants of primordial risk factors, may provide a means to improve population health and reduce cardiovascular health disparities.…”

Emergency transport of stroke suspects in a rural state: opportunities for improvement

“…Overall, the performance of EMS services for suspected stroke cases was very good and comparable with similar reports in the literature [12]; however, the appropriateness of destination choice was not confirmed, and the goal to improving care still remains.…”

The emotional stress and risk of ischemic stroke

“…The socioeconomic status affects the risk of ischemic stroke by increasing the risk of incident ischemic stroke in the most disadvantaged neighborhoods among whites, but not among blacks [13]. There are also differences in stroke mortality rates depending on the level of poverty, education, population density, population mobility and race/ethnicity pattern [14]. Such observations may be connected with stress, but what is more likelywith the lifestyle, medication use and access to healthcare providers.…”