Small-area racial disparity in stroke mortality: an application of bayesian spatial hierarchical modeling.

Abstract

In the United States, excess burden of stroke mortality has persisted among African Americans compared with whites despite declines in stroke mortality for both groups. New insights may be gleaned by examining local, small-area patterns in racial disparities in stroke. The study population includes all non-Hispanic African Americans and non-Hispanic whites aged 35 to 64 in the southeastern United States during 1999 to 2002. We assessed county-level numbers of stroke deaths and population estimates in a Bayesian spatial hierarchical modeling framework allowing for inclusion of potential covariates (poverty and rurality), and generating county-specific model-based estimates of both absolute and relative racial disparity. The resulting estimates of race-specific stroke death rates, relative racial disparity, and absolute racial disparity were expressed in maps. After adjustment for age, poverty, and rurality, county-level estimates of relative racial disparity ranged from 2.3 to 3.3 and estimates of absolute racial disparity ranged from 19 to 45 excess deaths per 100,000. For both racial groups, stroke death rates were higher in rural areas and with increasing poverty. High relative racial disparity was concentrated primarily in the eastern portion of the region and large absolute racial disparity was concentrated primarily in the western portion. The results highlight the pervasiveness and magnitude of substantial local racial disparities in stroke mortality in the southeast.