Geographic disparities in heart disease and stroke mortality among black and white populations in the Appalachian region.

In this paper, we examine geographic and racial/ethnic differences in heart disease and stroke mortality in the Appalachian region. Initial comparisons are made between national rates for heart disease and stroke mortality and those for the Appalachian region. County-level analyses were performed to examine the relative mortality experience of populations in Appalachian counties compared to other counties in the United States and to assess the degree of geographic disparity in mortality from heart disease and stroke among these race/ethnic and gender groups within Appalachia. The Appalachian region exhibits higher rates of both heart disease and stroke mortality for all race/ethnic, gender, and age groups examined. We found that many counties in the Appalachian region endure a considerable burden of the national excess in both heart disease and stroke mortality, and these counties tend to be aggregated in particular areas as opposed to being dispersed regionwide. Finally, we compare 2 groups of counties in Appalachia based on the designation as an "economically distressed county," defined by the Appalachian Regional Commission. As a group, distressed counties in Appalachia exhibit higher rates of both heart disease and stroke mortality than the rest of Appalachia.