CHANGES IN THE GEOGRAPHIC PATTERN OF STROKE MORTALITY IN THE UNITED-STATES, 1962 TO 1988
CHANGES IN THE GEOGRAPHIC PATTERN OF STROKE MORTALITY IN THE UNITED-STATES, 1962 TO 1988
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DOI：
10.1161/01.str.26.5.755
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发表时间：
1995-05-01
期刊：
影响因子：
8.3
通讯作者：
POLLARD, RA
中科院分区：
文献类型：
--
作者：
CASPER, ML;WING, S;POLLARD, RA
背景和目的卒中带--美国东南部高卒中死亡率的集中地--的致病因素尚不清楚。之前关于该地区物理性质的假设尚未得到证实。这项研究描述了卒中死亡率最高地区的位置变化以及对卒中带新假设的影响。方法我们使用三段对数线性回归模型计算了1962至1988年间黑人女性、黑人男性、白人女性和白人男性的年中风死亡率。绘制的地图以州经济区(SEA)为分析单位。1962年，基线卒中带被定义为高五分之一海区最集中的区域。结果高流速海区的集中度有从东南部山前地区向密西西比河流域转移的趋势。例如，1962年，在黑人女性中，基线中风带上72%的海洋处于最高五分之一，而到1988年，这一比例下降到48%。在其他种族/性别组中也观察到了类似的模式。结论中风死亡率最高地区位置的时间变化表明，理解中风死亡率地理模式的新假设应该考虑各种医学、社会经济和行为因素的时间趋势。
Background and Purpose The factors that contribute to the Stroke Belt-a concentration of high stroke mortality rates in the southeastern United States-remain unidentified. Previous hypotheses that focused on physical properties of the area have not been confirmed. This study describes changes in the locations of areas with the highest rates of stroke mortality and the implications for new hypotheses regarding the Stroke Belt.Methods We calculated annual, age-adjusted stroke mortality rates for black women, black men, white women, and white men for the years 1962 to 1988 using a three-piece log-linear regression model. Maps were produced with the state economic area (SEA) as the unit of analysis. The baseline Stroke Belt was defined as the area with the largest concentration of high-quintile SEAs in 1962.Results The concentration of high-rate SEAs tended to shift away from the Piedmont region of the Southeast and toward the Mississippi River valley. For example, whereas among black women in 1962, 72% of SEAs in the baseline Stroke Belt were in the highest quintile, by 1988 this percentage had dropped to 48%. Similar patterns were observed for the other race/sex groups.Conclusions Temporal changes in the location of areas with the highest stroke mortality rates suggest that new hypotheses for understanding the geographic pattern of stroke mortality should consider temporal trends in a variety of medical, socioeconomic, and behavioral factors.