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Although deaths from stroke have been reduced by 75% in the past 54 years, there has been virtually no reduction in the relative magnitude of Black‐to‐White disparity in stroke deaths, or the heavier burden of stroke deaths in the Stroke Belt region of the United States. Furthermore, although the rural–urban disparity has decreased in the past decade, this reduction is largely attributable to an increased stroke mortality in the urban areas, rather than reduced stroke mortality in rural areas. We need to focus our search for interventions to reduce disparities on those that benefit the disadvantaged populations, and support this review using relatively recently developed statistical approaches to estimate the magnitude of the potential reduction in the disparities.

BackgroundStroke is associated with racial disparities in morbidity and mortality and stroke outcomes. Stroke literacy is a significant predictor of on-time arrival to the emergency room for acute stroke treatment. In this study, we examined sociodemographic and socioeconomic factors that predict key aspects of stroke literacy: knowledge of stroke signs/symptoms and intent to call 911 in the event of a stroke.MethodsWe analyzed archived data from a survey of African American adults over 18 years residing in the “buckle of the stroke belt.” Participants were ranked into 2 categories: low or no and moderate to adequate stroke knowledge. Then we performed univariate and multivariable analyses to determine the independent predictors of (1) knowledge of stroke signs and symptoms and (1) intent to call 911.ResultsParticipants aged 18–39 years (OR = 0.46, 95% CI: 0.27– 0.80) were more likely to correctly recognize stroke signs and symptoms compared to those who are 65 years and above. Those age 40–64 years were also more likely to recognize stroke signs and symptoms compared to those who are 65 years and above. On the other hand, those with less than high school (OR = 2.83, 95% CI: 2.03–3.96) or complete high school education (OR = 1.95, 95% CI: 1.28–2.96) were less likely to recognize stroke signs and symptoms. Males were less likely (OR = 0.65, 95% CI: 0.64–0.66) to report that they would call 911 in the event of a stroke. While respondents aged 40–64 years (OR = 1.87, 95% CI: 1.14–3.09) and those with moderate to adequate knowledge of stroke (OR = 1.39, 95% CI: 1.18–1.65) were more likely to call 911 in the event of a stroke. Socioeconomic status was generally associated with stroke literacy.ConclusionAmong resident of the “buckle of the stroke belt,” we observed that age, sex, and educational level are among the key predictors of knowledge of stroke signs and symptoms and intent to call 911 in the event of a stroke. Stroke literacy and educational programs needs to incorporate these key sociodemographic aspects as a strategy for improving literacy and reduce stroke-related disability and health disparities.

Abstract Although hypertension is a contributing factor to higher stroke occurrence in the Stroke Belt, little is known about post‐stroke hypertension medication use in Stroke Belt residents. Through the use of national Behavioral Risk Factor Surveillance System surveys from 2015, 2017, and 2019; we compared unadjusted and adjusted estimates of post‐stroke hypertension medication use by Stroke Belt residence status. Similar levels of post‐stroke hypertension medication use were observed between Stroke Belt residents (OR: 1.09, 95% CI: 0.89, 1.33) and non‐Stroke Belt residents. After adjustment, Stroke Belt residents had 1.14 times the odds of post‐stroke hypertension medication use (95% CI: 0.92, 1.41) compared to non‐Stroke Belt residents. Findings from this study suggest that there is little difference between post‐stroke hypertension medication use between Stroke Belt and non‐Stroke Belt residents. However, further work is needed to assess whether use of other non‐medicinal methods of post‐stroke hypertension control differs by Stroke Belt residence status.

This paper uses data from the Diet and Health Study (DHS) to examine associations between being born in a “stroke belt” state and old age stroke and mortality outcomes. Adding to prior work that used administrative data, our paper explores educational and health mechanisms that are both stratified by geography and by mortality outcomes. Using logistic regression, we first replicate earlier findings of elevation in risk of dementia mortality (OR 1.13, CI [1.07, 1.20]) and stroke mortality (OR 1.17, CI [1.07, 1.29]) for white individuals born in a stroke belt state. These associations are largely unaffected by controls for educational attainment or by experiences with surviving a stroke and are somewhat attenuated by controls for self-rated health status in old age. The results suggest a need to consider additional life course mechanisms in order to understand the persistent effects of place of birth on old age mortality patterns.

The southern United States (US) sustains a disproportionate burden of incident stroke and associated mortality, compared to other parts of the US. A large proportion of this risk remains unexplained. Petroleum production and refining (PPR) is concentrated within this region and emits multiple pollutants implicated in stroke pathogenesis. The relationship between residential PPR exposure and stroke has not been studied. We aimed to investigate the census tract-level association between residential PPR exposure and stroke prevalence for adults (⩾18 years) in seven southern US states in 2018. We conducted spatial distance- and generalized propensity score-matched analysis that adjusts for sociodemographic factors, health behavioral factors, and unmeasured spatial confounding. PPR was measured as inverse-distance weighted averages of petroleum production within 2.5 km or 5 km from refineries, which was strongly correlated with measured levels of sulfur dioxide, a byproduct of PPR. The prevalence of self-reported stroke ranged from 0.4% to 12.7% for all the census tracts of the seven states. People with low socioeconomic status and of Hispanic ethnicity resided closer to petroleum refineries. The non-Hispanic Black population was exposed to higher PPR, while the non-Hispanic White population was exposed to lower PPR. Residential PPR exposure was significantly associated with stroke prevalence. One standard deviation increase in PPR within 5 km from refineries was associated with 0.22 (95% confidence interval: 0.09, 0.34) percentage point increase in stroke prevalence. PPR explained 5.6% (2.4, 8.9) of stroke prevalence in the exposed areas. These values differed by states: 1.1% (0.5, 1.7) in Alabama to 11.7% (4.9, 18.6) in Mississippi, and by census tract-level: 0.08% (0.03, 0.13) to 25.3% (10.6, 40.0). PPR is associated with self-reported stroke prevalence, suggesting possible links between pollutants emitted from refineries and stroke. The increased prevalence due to PPR may differ by sociodemographic factors.

The Mediterranean diet (MedDiet) is recommended by the current Dietary Guidelines for Americans, yet little is known about the perceived barriers and benefits to the diet in the U.S., particularly in the Stroke Belt (SB). Thus, the purpose of this study was to examine MedDiet adherence and perceived knowledge, benefits, and barriers to the MedDiet in the U.S. A cross-sectional study was conducted on 1447 participants in the U.S., and responses were sorted into geographic groups: the SB, California (CA), and all other US states (OtherUS). Linear models and multivariable linear regression analysis was used for data analysis. Convenience, sensory factors, and health were greater barriers to the MedDiet in the SB group, but not the OtherUS group (p < 0.05). Weight loss was considered a benefit of the MedDiet in the SB (p < 0.05), while price and familiarity were found to be less of a benefit (p < 0.05). Respondents with a bachelor’s degree or greater education had greater total MEDAS scores (p < 0.05) and obese participants had a lower MedDiet adherence score (p < 0.05). Our results identify key barriers and benefits of the MedDiet in the SB which can inform targeted MedDiet intervention studies.