Lanska D J, Peterson P M
Department of Neurology, University of Kentucky, Lexington 40536-0284, USA.
Stroke. 1995 Apr;26(4):554-61. doi: 10.1161/01.str.26.4.554.
This study examines the effects of lifetime net interstate migration on the geographic distribution of stroke mortality in the United States.
National Center for Health Statistics and Bureau of the Census data were used to map the geographic distribution of age-adjusted, race-, and race/sex-specific stroke mortality rates by interstate migration status for natives, outmigrants, nonmigrants, inmigrants, and residents in the United States for 1979 to 1981.
High age-adjusted stroke mortality rates were significantly clustered in the southeastern United States for both whites and blacks; in addition, for whites, low-rate states were concentrated in some Mountain and northeastern states. Migrant status did not change this large-scale pattern, but individual states showed significant migration effects, which varied in magnitude and direction. Among whites, states that benefited from migration, with markedly lower stroke mortality rates among residents than natives, included Arizona, Colorado, District of Columbia, and Florida, whereas states that suffered from migration included California, Idaho, Montana, North Dakota, Nevada, and Oklahoma. Among blacks, only Colorado showed an apparent large benefit from migration, whereas 21 states suffered from migration.
Although the overall large-scale spatial distribution of resident stroke mortality rates cannot be explained by migration effects, some individual states had rates that were strongly influenced by migration. Patterns of mortality among migrant groups in Sun Belt retirement destination states probably result from differential selection effects for retirement migration in older adults. Patterns of mortality for black migrants to the North are probably influenced by "carryover" effects from their origin states.
本研究探讨终生跨州净迁移对美国中风死亡率地理分布的影响。
利用国家卫生统计中心和人口普查局的数据，绘制了1979年至1981年美国本土居民、迁出者、非迁移者、迁入者和居民按州际迁移状况划分的年龄调整后、按种族和种族/性别分类的中风死亡率地理分布。
经年龄调整的高中风死亡率在美国东南部白人和黑人中均显著聚集；此外，对于白人而言，低死亡率州集中在一些山区和东北部州。迁移状况并未改变这种大规模模式，但个别州显示出显著的迁移效应，其大小和方向各不相同。在白人中，从迁移中受益的州，其居民中风死亡率明显低于本土居民，包括亚利桑那州、科罗拉多州、哥伦比亚特区和佛罗里达州，而受迁移影响的州包括加利福尼亚州、爱达荷州、蒙大拿州、北达科他州、内华达州和俄克拉何马州。在黑人中，只有科罗拉多州显示出明显的迁移益处，而21个州受迁移影响。
虽然居民中风死亡率的总体大规模空间分布不能用迁移效应来解释，但一些个别州的死亡率受到迁移的强烈影响。阳光地带退休目的地州移民群体的死亡率模式可能源于老年人退休迁移的差异选择效应。北方黑人移民的死亡率模式可能受到其原籍州“遗留”效应的影响。
