Abstract WMP103: Tightening of the Stroke Belt

Abstract

Background: Higher stroke mortality in the Southeastern United States has been recognized for over 80 years, but recent trends from in Stroke Belt (SB) vs non-SB stroke death rates have not been well delineated. Methods: We analyzed stroke-related annual age-adjusted mortality rates (AAMR) in the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) database from 1999-2019, comparing the 8 SB states (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee) and 42 non-SB states among all individuals and subgroups of age, sex, race-ethnicity, and urban-rural. AAMRs reported per 100,000 individuals. Results: Throughout the 1999-2019 period, AAMRs were higher in the SB than non-SB. Both SB and non-SB states showed rapid AAMR decline from 1999 - 2009, then slow decline 2009-2014, and plateau 2014-2019. Yet, SB AAMR declined more rapidly. AAMRs in 1999, 2009, and 2019 in the SB were 122.60, 80.54, and 73.52; in the non-Stroke Belt 100.84, 64.14, and 61.35). As a result, the number of SB states with substantially elevated AAMR compared with non-SB states fell from 7 in 1999 to 6 in 2009 and 2 (MS, TN) in 2019 (Figure). Age, sex, and urban-rural subgroup trends resembled the overall population. Yet, race-ethnic variations were noted. Throughout the study period in the SB, Black individuals had the highest AAMRs but had a steeper decline than White individuals, with the gap narrowing from 49.50 (163.06 vs 113.56) in 1999 to 28.45 (96.97 vs 68.52) in 2019. AAMRs for Hispanic and Asian individuals were lower than White individuals throughout the study period in the SB and dropped more steeply for Asian (76.18 to 46.76) than Hispanic individuals (54.50 to 35.61). Conclusions: Stroke mortality declined more steeply between 1999-2019 in the Southeastern US than the rest of the country. Substantial SB race-ethnic disparities persist, with AAMRs highest in Black, intermediate in White, and lowest in Asian and Hispanic individuals.