Glymour M Maria, Kosheleva Anna, Boden-Albala Bernadette
Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA, USA.
Neurology. 2009 Dec 1;73(22):1858-65. doi: 10.1212/WNL.0b013e3181c47cad.
Understanding how the timing of exposure to the US Stroke Belt (SB) influences stroke risk may illuminate mechanisms underlying the SB phenomenon and factors influencing population stroke rates.
Stroke mortality rates for United States-born black and white people aged 30-80 years were calculated for 1980, 1990, and 2000 for strata defined by birth state, state of adult residence, race, sex, and birth year. Four SB exposure categories were defined: born in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) and lived in the SB at adulthood; non-SB born but SB adult residence; SB-born but adult residence outside the SB; and did not live in the SB at birth or in adulthood (reference group). We estimated age-, sex-, and race-adjusted odds ratios for stroke mortality associated with timing of SB exposure.
Elevated stroke mortality was associated with both SB birth and, independently, SB adult residence, with the highest risk among those who lived in the SB at birth and adulthood. Compared to those living outside the SB at birth and adulthood, odds ratios for SB residence at birth and adulthood for black subjects were 1.55 (95% confidence interval 1.28, 1.88) in 1980, 1.47 (1.31, 1.65) in 1990, and 1.34 (1.22, 1.48) in 2000. Comparable odds ratios for white subjects were 1.45 (95% confidence interval 1.33, 1.58), 1.29 (1.21, 1.37), and 1.34 (1.25, 1.44). Patterns were similar for every race, sex, and age subgroup examined.
Stroke Belt birth and adult residence appear to make independent contributions to stroke mortality risk.
了解暴露于美国卒中带（SB）的时间如何影响卒中风险，可能会阐明SB现象背后的机制以及影响人群卒中发生率的因素。
根据出生州、成年居住州、种族、性别和出生年份划分的不同层次，计算了1980年、1990年和2000年出生于美国的30至80岁黑人和白人的卒中死亡率。定义了四种SB暴露类别：出生于SB州（北卡罗来纳州、南卡罗来纳州、佐治亚州、田纳西州、阿肯色州、密西西比州或阿拉巴马州）且成年后居住在SB地区；非SB州出生但成年后居住在SB地区；出生于SB州但成年后居住在SB地区以外；出生时和成年时均未居住在SB地区（参照组）。我们估计了与SB暴露时间相关的卒中死亡率的年龄、性别和种族调整比值比。
卒中死亡率升高与出生于SB州以及独立的成年后居住在SB地区均有关联，出生时和成年时均居住在SB地区的人群风险最高。与出生时和成年时均居住在SB地区以外的人群相比，1980年黑人受试者出生时和成年时居住在SB地区的比值比为1.55（95%置信区间1.28, 1.88），1990年为1.47（1.3, 1.65），2000年为1.34（1.22, 1.48）。白人受试者的可比比值比分别为1.45（95%置信区间1.33, 1.58）、1.29（1.21, 1.37）和1.34（1.25, 1.44）。在所研究的每个种族、性别和年龄亚组中，模式相似。
出生于卒中带以及成年后居住在卒中带似乎对卒中死亡风险有独立的影响。
