Casper M L, Wing S, Anda R F, Knowles M, Pollard R A
Cardiovascular Health Studies Branch, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
Stroke. 1995 May;26(5):755-60. doi: 10.1161/01.str.26.5.755.
The factors that contribute to the Stroke Belt--a concentration of high stroke mortality rates in the southeastern United States--remain unidentified. Previous hypotheses that focused on physical properties of the area have not been confirmed. This study describes changes in the locations of areas with the highest rates of stroke mortality and the implications for new hypotheses regarding the Stroke Belt.
We calculated annual, age-adjusted stroke mortality rates for black women, black men, white women, and white men for the years 1962 to 1988 using a three-piece log-linear regression model. Maps were produced with the state economic area (SEA) as the unit of analysis. The baseline Stroke Belt was defined as the area with the largest concentration of high-quintile SEAs in 1962.
The concentration of high-rate SEAs tended to shift away from the Piedmont region of the Southeast and toward the Mississippi River valley. For example, whereas among black women in 1962, 72% of SEAs in the baseline Stroke Belt were in the highest quintile, by 1988 this percentage had dropped to 48%. Similar patterns were observed for the other race/sex groups.
Temporal changes in the location of areas with the highest stroke mortality rates suggest that new hypotheses for understanding the geographic pattern of stroke mortality should consider temporal trends in a variety of medical, socioeconomic, and behavioral factors.
导致卒中带（美国东南部卒中死亡率集中高发的区域）出现的因素仍不明确。以往聚焦于该地区物理特性的假说尚未得到证实。本研究描述了卒中死亡率最高地区的位置变化及其对卒中带新假说的影响。
我们使用三段对数线性回归模型计算了1962年至1988年黑人女性、黑人男性、白人女性和白人男性的年度年龄调整卒中死亡率。以州经济区（SEA）作为分析单位绘制地图。基线卒中带定义为1962年高五分位数SEA最集中的区域。
高发病率SEA的集中区域倾向于从东南部的皮埃蒙特地区向密西西比河谷转移。例如，1962年基线卒中带中，黑人女性中有72%的SEA处于最高五分位数，到1988年这一比例降至48%。其他种族/性别组也观察到类似模式。
卒中死亡率最高地区位置的时间变化表明，理解卒中死亡率地理模式的新假说应考虑各种医学、社会经济和行为因素的时间趋势。
