Incidence and Case Fatality at the County Level As Contributors to Geographic Disparities in Stroke Mortality

Overview

Journal Neuroepidemiology

Specialties Neurology
Public Health

Date 2016 Sep 15

PMID 27626792

Citations 13

Authors

Darwin R Labarthe

George Howard

Monika M Safford

Virginia J Howard

Suzanne E Judd

Mary Cushman

Brett M Kissela

Affiliations

Soon will be listed here.

Abstract

Background: Is the high stroke mortality in the Southeastern parts of the United States driven by differences in stroke incidence or case-fatality? This question remains unanswered. Differences in incidence would underscore the need for stroke prevention, while differences in case fatality would call for improved stroke care.

Methods: Quartiles of US counties were defined by stroke mortality, and this gradient was related with stroke incidence and stroke case fatality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, where 1,317 incident stroke events (of which 242 were fatal) occurred among 29,650 participants.

Results: There was a significant (p = 0.0025) gradient of fatal stroke events in REGARDS (quartile 4 vs. quartile 1 (Q4/Q1) hazard ratio 1.95, 95% CI 1.35-2.81), demonstrating the consistency of REGARDS with national mortality data. The gradient for incident stroke (fatal + nonfatal) was also significant (p = 0.0023; Q4/Q1 hazard ratio 1.29, 95% CI 1.10-1.52). The gradient for stroke case-fatality was marginally significant (p = 0.058), though the OR for Q4/Q1 (1.71, 95% CI 1.13-2.25) was large.

Conclusions: Both stroke incidence and case-fatality in REGARDS appear to be contributing, underscoring the need for strengthening both stroke prevention and acute stroke care in order to reduce the disparity.

Citing Articles

Temporal Trends and Racial Disparities in Long-Term Survival After Stroke.

Robinson D, Ding L, Howard G, Stanton R, Khoury J, Sucharew H Neurology. 2024; 103(3):e209653.

PMID: 39008784 PMC: 11249510. DOI: 10.1212/WNL.0000000000209653.

Health Equity and Actionable Disparities in Stroke: Understanding and Problem-Solving 2023 Update.

Towfighi A, Ovbiagele B J Am Heart Assoc. 2024; 13(7):e031306.

PMID: 38529646 PMC: 11179747. DOI: 10.1161/JAHA.124.031306.

Sherman Lecture: Are We Aiming at the Correct Targets to Reduce Disparities in Stroke Mortality? Celebration, Reflection, and Redirection.

Howard G J Am Heart Assoc. 2024; 13(7):e031309.

PMID: 38529644 PMC: 11179784. DOI: 10.1161/JAHA.123.031309.

Social Determinants of Stroke Hospitalization and Mortality in United States' Counties.

Yadav R, Chaudhary D, Avula V, Shahjouei S, Azarpazhooh M, Abedi V J Clin Med. 2022; 11(14).

PMID: 35887865 PMC: 9320068. DOI: 10.3390/jcm11144101.

The significant places of African American adults and their perceived influence on cardiovascular disease risk behaviors.

White M, Holliday K, Hoover S, Robinson-Ezekwe N, Corbie-Smith G, Williams A BMC Public Health. 2021; 21(1):2018.

PMID: 34740336 PMC: 8570769. DOI: 10.1186/s12889-021-12022-x.

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