243 results on '"Stroke Belt"'
Search Results
2. Predictors of stroke literacy among African Americans in the 'buckle of the stroke belt'
- Author
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N. Abimbola Sunmonu, Angela M. Malek, Carolyn Jenkins, and Hyacinth I. Hyacinth
- Subjects
African Americans ,stroke ,stroke belt ,health disparities ,knowledge and awareness ,health literacy ,Medicine - Abstract
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.
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- 2024
- Full Text
- View/download PDF
3. Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A "Stroke Belt" Region of Southern Europe.
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del Toro-Pérez, Cristina, Amaya-Pascasio, Laura, Guevara-Sánchez, Eva, Ruiz-Franco, María Luisa, Arjona-Padillo, Antonio, and Martínez-Sánchez, Patricia
- Subjects
- *
STROKE , *STROKE patients , *THROMBECTOMY , *ISCHEMIC stroke - Abstract
The aim of this 4-year observational study is to analyze the outcomes of stroke patients treated with direct mechanical thrombectomy (dMT) compared to bridging therapy (BT) (intravenous thrombolysis [IVT] + BT) based on 3-month outcomes, in real clinical practice in the "Stroke Belt" of Southern Europe. In total, 300 patients were included (41.3% dMT and 58.6% BT). The frequency of direct referral to the stroke center was similar in the dMT and BT group, whereas the time from onset to groin was longer in the BT group (median 210 [IQR 160–303] vs. 399 [IQR 225–675], p = 0.001). Successful recanalization (TICI 2b-3) and hemorrhagic transformation were similar in both groups. The BT group more frequently showed excellent outcomes at 3 months (32.4% vs. 15.4%, p = 0.004). Multivariate analysis showed that BT was independently associated with excellent outcomes (OR 2.7. 95% CI,1.2–5.9, p = 0.02) and lower mortality (OR 0.36. 95% CI 0.16–0.82, p = 015). Conclusions: Compared with dMT, BT was associated with excellent functional outcomes and lower 3-month mortality in this real-world clinical practice study conducted in a region belonging to the "Stroke Belt" of Southern Europe. Given the disparity of results on the benefit of BT in the current evidence, it is of vital importance to analyze the convenience of its use in each health area. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. Duration of employment within occupations and incident stroke in a US general population cohort 45 years of age or older (REGARDS study).
- Author
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Huynh, Tran B., McClure, Leslie A., Howard, Virginia J., Stafford, Monika M., Judd, Suzanne E., and Burstyn, Igor
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STROKE ,STROKE patients ,HEMORRHAGIC stroke ,DISEASE risk factors ,OLD age ,ISCHEMIC stroke ,DISABILITY retirement - Abstract
Background: The work environment can contribute to the risk of cardiovascular diseases (CVD) including stroke. Our objective was to identify occupations with elevated risk of stroke within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Methods: We analyzed incident stroke outcomes (ischemic and hemorrhagic strokes) from 2003 to 2020 and employment characteristics of 13,659 adults aged ≥45 years enrolled in a national population‐based cohort study. Using a modified Poisson regression approach, we estimated the relative risks (RRs) and the associated 95% confidence intervals (CI) of stroke in relation to years of employment within each occupation coded using the US Census two‐digit Standard Occupation Code. Models were adjusted for Framingham Stroke Risk Score, region, race, age, and body mass index. We conducted stratified analysis by sex, employment time period (pre‐1975 vs. post‐1975), and region. Results: Workers in the following occupations had a greater risk of stroke with longer duration of employment (per decade): protective service (RR: 2.35, 95% CI: 1.11, 4.97), food preparation and service (RR: 1.51, 95% CI: 1.05, 2.19), and transportation and material moving (RR: 1.30, 95% CI: 1.00, 1.69). The stroke risk in these occupations was disproportionately elevated in men, and differed by region and employment time period. Conclusions: Longer employment in protective service, food preparation and serving, and transportation and materials moving occupations may increase the risk of stroke. Surveillance may uncover specific work‐related risk factors in these occupations, leading to interventions to reduce the burden of stroke among US workers. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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5. A comparison of post‐stroke hypertension medication use between US Stroke Belt and Non‐Stroke Belt residents
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Phoebe Tran, Lam Tran, and Liem Tran
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hypertension ,medication use ,stroke ,Stroke Belt ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
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.
- Published
- 2021
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6. Association and pathways of birth in the stroke belt on old age dementia and stroke Mortality
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Michael Topping, Jinho Kim, and Jason Fletcher
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Stroke belt ,Life course ,Dementia mortality ,Geographic variation ,Education ,Public aspects of medicine ,RA1-1270 ,Social sciences (General) ,H1-99 - Abstract
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.
- Published
- 2021
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7. A comparison of post-stroke hypertension medication use between US Stroke Belt and Non-Stroke Belt residents.
- Author
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Tran, Phoebe, Tran, Lam, and Tran, Liem
- Subjects
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HYPERTENSION epidemiology , *HYPERTENSION , *STROKE , *RISK assessment - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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8. Sherman Lecture: Are We Aiming at the Correct Targets to Reduce Disparities in Stroke Mortality? Celebration, Reflection, and Redirection.
- Author
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Howard G
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- United States epidemiology, Humans, Rural Population, Health Status Disparities, White, Stroke therapy
- Abstract
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.
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- 2024
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9. Residential exposure to petroleum refining and stroke in the southern United States
- Author
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Honghyok Kim, Natalia Festa, Kate Burrows, Dae Cheol Kim, Thomas M Gill, and Michelle L Bell
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stroke belt ,oil industry ,petroleum refinery ,environmental pollution ,environmental justice ,small-area variation in stroke ,Environmental technology. Sanitary engineering ,TD1-1066 ,Environmental sciences ,GE1-350 ,Science ,Physics ,QC1-999 - Abstract
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.
- Published
- 2022
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10. Ideal telestroke time targets: Telestroke-based treatment times in the United States stroke belt.
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Nalleballe, Krishna, Sharma, Rohan, Brown, Aliza, Joiner, Renee, Kapoor, Nidhi, Morgan, Tiffany, Benton, Tina, Williamson, Conelia, Culp, William, Lowery, Curtis, and Onteddu, Sanjeeva
- Subjects
- *
FIBRINOLYTIC agents , *STROKE patients , *DATA analysis , *THROMBOLYTIC therapy , *COMPUTED tomography , *TISSUE plasminogen activator - Abstract
Background: Studying critical time interval requirements can enhance thrombolytic treatment for stroke patients in telestroke networks. We retrospectively examined 12 concurrent months of targeted time interval information in the South Central US telemedicine programme, Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES).Hypothesis: We hypothesised that consult data analysis would highlight areas for improvement to shorten overall door to Intra venous (IV) tissue plasminogen activator (tPA) administration time.Methods: We analysed critical time targets for 238 consecutive telestroke neurology consults obtained over 12 months from AR SAVES spoke sites when tPA was administered. The following time intervals were analysed: emergency department (ED) door to Computed Tomography (D-CT); ED door to call centre (D-CC) for initiation of consult; ED door to neurology call (D-NC); neurology call to camera (NC-Cam); tele consult time (Con); ED door to tissue plasminogen activator (tPA)/needle (DTN).Results: The median times of D-CT (13 min, inter quartile range (IQR) 6–22 min), D-CC (34 min, IQR 20–45 min), D-NC (40 min, IQR 21–71 min), NC-Cam (4 min, IQR 2–8 min), and Con (25 min, IQR 17–37 min) all contributed to a DTN median time of 71 min (IQR 50–104 min). A total of 238 patients received tPA with a 29.4% treatment rate and a DTN time of ≤60 min was achieved in 25.2% of patients.Conclusions: Focusing on reducing D-CC and Con times may help to achieve the DTN time of < 60 min for the majority of patients. Having ideal time targets for telestroke patients akin to traditional patients will help identify and improve the overall goal of a DTN time < 60 min. [ABSTRACT FROM AUTHOR]- Published
- 2020
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11. Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A “Stroke Belt” Region of Southern Europe
- Author
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Cristina del Toro-Pérez, Laura Amaya-Pascasio, Eva Guevara-Sánchez, María Luisa Ruiz-Franco, Antonio Arjona-Padillo, and Patricia Martínez-Sánchez
- Subjects
stroke belt ,acute ischemic stroke ,transfer model ,bridging therapy ,direct mechanical thrombectomy ,Medicine (miscellaneous) ,intravenous thrombolysis - Abstract
The aim of this 4-year observational study is to analyze the outcomes of stroke patients treated with direct mechanical thrombectomy (dMT) compared to bridging therapy (BT) (intravenous thrombolysis [IVT] + BT) based on 3-month outcomes, in real clinical practice in the "Stroke Belt" of Southern Europe. In total, 300 patients were included (41.3% dMT and 58.6% BT). The frequency of direct referral to the stroke center was similar in the dMT and BT group, whereas the time from onset to groin was longer in the BT group (median 210 [IQR 160–303] vs. 399 [IQR 225–675], p = 0.001). Successful recanalization (TICI 2b-3) and hemorrhagic transformation were similar in both groups. The BT group more frequently showed excellent outcomes at 3 months (32.4% vs. 15.4%, p = 0.004). Multivariate analysis showed that BT was independently associated with excellent outcomes (OR 2.7. 95% CI,1.2–5.9, p = 0.02) and lower mortality (OR 0.36. 95% CI 0.16–0.82, p = 015). Conclusions: Compared with dMT, BT was associated with excellent functional outcomes and lower 3-month mortality in this real-world clinical practice study conducted in a region belonging to the “Stroke Belt” of Southern Europe. Given the disparity of results on the benefit of BT in the current evidence, it is of vital importance to analyze the convenience of its use in each health area.
- Published
- 2023
- Full Text
- View/download PDF
12. DIRECT MECHANICAL THROMBECTOMY VERSUS BRIDGING THERAPY FOR STROKE PATIENTS IN A SOUTHERN EUROPEAN 'STROKE BELT'
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Toro-Pérez, Cristina Del, Amaya-Pascasio, Laura, Guevara-Sánchez, Eva, Ruiz-Franco, Maria Luisa, Arjona Padillo, Antonio, and Martínez Sánchez, Patricia
- Subjects
stroke belt ,acute ischemic stroke ,transfer model ,bridging therapy ,direct mechanical thrombectomy ,intravenous thrombolysis - Abstract
The aim of this 4-year observational study is to analyze the outcomes of stroke patients treated with direct mechanical thrombectomy (dMT) compared to bridging therapy (BT) (intravenous thrombolysis [IVT] + BT) based on 3-month outcomes, in real clinical practice in the "Stroke Belt" of Southern Europe. In total, 300 patients were included (41.3% dMT and 58.6% BT). The frequency of direct referral to the stroke center was similar in the dMT and BT group, whereas the time from onset to groin was longer in the BT group (median 210 [IQR 160–303] vs. 399 [IQR 225–675], p = 0.001). Successful recanalization (TICI 2b-3) and hemorrhagic transformation were similar in both groups. The BT group more frequently showed excellent outcomes at 3 months (32.4% vs. 15.4%, p = 0.004). Multivariate analysis showed that BT was independently associated with excellent outcomes (OR 2.7. 95% CI,1.2–5.9, p = 0.02) and lower mortality (OR 0.36. 95% CI 0.16–0.82, p = 015). Conclusions: Compared with dMT, BT was associated with excellent functional outcomes and lower 3-month mortality in this real-world clinical practice study conducted in a region belonging to the “Stroke Belt” of Southern Europe. Given the disparity of results on the benefit of BT in the current evidence, it is of vital importance to analyze the convenience of its use in each health area.
- Published
- 2023
13. Determinants of stroke prevalence in the southeastern region of the United States.
- Author
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Ilunga Tshiswaka, Daudet, Ibe-Lamberts, Kelechi D., Fazio, Michael, Morgan, John Derek, Cook, Courtney, and Memiah, Peter
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STROKE risk factors ,AGE distribution ,CHI-squared test ,CONFIDENCE intervals ,DIET ,ALCOHOL drinking ,FOOD habits ,MULTIVARIATE analysis ,STATISTICS ,STROKE ,VEGETABLES ,LOGISTIC regression analysis ,SECONDARY analysis ,SOCIOECONOMIC factors ,DISEASE prevalence ,DATA analysis software ,HEALTH & social status ,STROKE patients ,DESCRIPTIVE statistics ,ODDS ratio - Abstract
Purpose: The southeast of the United States (USA) is a high stroke prevalence area otherwise known as the "Stroke Belt" in order to characterize the increased stroke morbidity and mortality rates found there. The purpose of this study was to characterize the relationship between socio-cultural factors and dietary habits related to stroke occurrence within the affected states. Methods: The 2015 Behavioral Risk Factor Surveillance System (BRFSS) data was analyzed for both bivariate and multivariate models aimed at studying the interaction between socio-cultural factors and the prevalence pattern of stroke in the southeastern area of the USA. Results: Overall, 4% of individuals who lived in the US southeastern states of Alabama, Florida, Georgia, Louisiana, and Mississippi had stroke. Of these, Mississippi had the most stroke victims, followed by Alabama, Louisiana, Georgia, and Florida, with 5.1%, 4.7%, 4.5%, 4.3%, and 3.4% respectively (χ
2 = 18.68 and p value < 0.01). The logistic regression showed that individuals who consumed vegetables every day were less likely to be stroke victims than those who did not consume vegetables on a daily basis, with aOR = 0.74; CI = 0.59–0.91; p value < 0.01. Surprisingly, individuals who drank alcohol were less likely to report stroke than those who did not drink alcohol (aOR = 0.63; CI = 0.51–0.79; p value < 0.001). Conclusion: Characterization of factors associated with stroke prevalence in a region of the USA known for its adverse stroke rates is essential for offsetting the burden of this public health issue and for promoting health. [ABSTRACT FROM AUTHOR]- Published
- 2019
- Full Text
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14. Geographic Inequalities in Cardiovascular Mortality in the United States: 1999 to 2018
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Pankaj Arora, Ana F. Best, Vibhu Parcha, Sarabjeet S. Suri, Thomas J. Wang, Nirav Patel, Rajat Kalra, and Garima Arora
- Subjects
Adult ,Male ,Adolescent ,Inequality ,media_common.quotation_subject ,Disease ,Young Adult ,Humans ,Medicine ,International Statistical Classification of Diseases and Related Health Problems ,Stroke ,Stroke Belt ,Aged ,Cardiovascular mortality ,media_common ,Aged, 80 and over ,business.industry ,Mortality rate ,Health Status Disparities ,General Medicine ,Middle Aged ,medicine.disease ,United States ,Cardiovascular Diseases ,Heart failure ,Female ,business ,Demography - Abstract
Objective To evaluate the trends in cardiovascular, ischemic heart disease (IHD), stroke, and heart failure mortality in the stroke belt in comparison with the rest of the United States. Patients and Methods We evaluated the nationwide mortality data of all Americans from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database from 1999 to 2018. Cause-specific deaths were identified in the stroke belt and nonstroke belt populations using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes. The relative percentage gap was estimated as the absolute difference computed relative to nonstroke belt mortality. Piecewise linear regression and age-period-cohort modeling were used to assess, respectively, the trends and to forecast mortality across the 2 regions. Results The cardiovascular mortality rate (per 100,000 persons) was 288.3 (95% CI, 288.0 to 288.6; 3,684,273 deaths) in the stroke belt region and 251.2 (95% CI, 251.0 to 251.3; 13,296,164 deaths) in the nonstroke belt region. In the stroke belt region, age-adjusted mortality rates due to all cardiovascular causes (average annual percentage change [AAPC] in mortality rates, −2.4; 95% CI, −2.8 to −2.0), IHD (AAPC, −3.8; 95% CI, −4.2 to −3.5), and stroke (AAPC, −2.8; 95% CI, −3.4 to −2.1) declined from 1999 to 2018. A similar decline in cardiovascular (AAPC, −2.5; 95% CI, −3.0 to −2.0), IHD (AAPC, −4.0; 95% CI, −4.3 to −3.7), and stroke (AAPC, −2.9; 95% CI, −3.2 to −2.2) mortality was seen in the nonstroke belt region. There was no overall change in heart failure mortality in both regions (PAAPC>.05). The cardiovascular mortality gap was 11.8% in 1999 and 15.9% in 2018, with a modest reduction in absolute mortality rate difference (~7 deaths per 100,000 persons). These patterns were consistent across subgroups of age, sex, race, and urbanization status. An estimated 101,953 additional cardiovascular deaths need to be prevented from 2020 to 2025 in the stroke belt to ameliorate the gap between the 2 regions. Conclusion Despite the overall decline, substantial geographic disparities in cardiovascular mortality persist. Novel approaches are needed to attenuate the long-standing geographic inequalities in cardiovascular mortality in the United States, which are projected to increase.
- Published
- 2021
15. Time to Bring Telestroke to Stroke Belt’s Hospitals
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Jeanette Carlin
- Subjects
telestroke ,stroke ,stroke belt ,Public aspects of medicine ,RA1-1270 - Published
- 2018
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16. A comparison of post‐stroke hypertension medication use between US Stroke Belt and Non‐Stroke Belt residents
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Liem Tran, Lam Tran, and Phoebe Tran
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medicine.medical_specialty ,hypertension ,Endocrinology, Diabetes and Metabolism ,Short Report ,medication use ,030204 cardiovascular system & hematology ,Odds ,Behavioral Risk Factor Surveillance System ,03 medical and health sciences ,0302 clinical medicine ,Short Reports ,Risk Factors ,parasitic diseases ,Internal Medicine ,medicine ,Humans ,cardiovascular diseases ,030212 general & internal medicine ,Residence.status ,Stroke ,Stroke Belt ,Medication use ,Hypertension control ,business.industry ,technology, industry, and agriculture ,equipment and supplies ,medicine.disease ,Emergency medicine ,Post stroke ,Cardiology and Cardiovascular Medicine ,business ,human activities - 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.
- Published
- 2021
17. The Mediterranean Diet in the Stroke Belt: A Cross-Sectional Study on Adherence and Perceived Knowledge, Barriers, and Benefits
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Caroline J. Knight, Olivia Jackson, Imran Rahman, Donna O. Burnett, Andrew D. Frugé, and Michael W. Greene
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Mediterranean diet ,adherence ,barriers and benefits ,Stroke Belt ,stages of change ,Nutrition. Foods and food supply ,TX341-641 - Abstract
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.
- Published
- 2019
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18. Risk Factors for Incident CKD in Black and White Americans: The REGARDS Study.
- Author
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Cheung KL, Crews DC, Cushman M, Yuan Y, Wilkinson K, Long DL, Judd SE, Shlipak MG, Ix JH, Bullen AL, Warnock DG, and Gutiérrez OM
- Subjects
- Humans, Female, United States epidemiology, Middle Aged, Aged, Male, Albuminuria epidemiology, White, Risk Factors, Glomerular Filtration Rate, Renal Insufficiency, Chronic, Stroke
- Abstract
Rationale & Objective: Little information exists on the incidence of and risk factors for chronic kidney disease (CKD) in contemporary US cohorts and whether risk factors differ by race, sex, or region in the United States., Study Design: Observational cohort study., Setting & Participants: 4,198 Black and 7,799 White participants aged at least 45 years, recruited from 2003 through 2007 across the continental United States, with baseline estimated glomerular filtration rate (eGFR)>60mL/min/1.73m
2 and eGFR assessed again approximately 9 years later., Exposures: Age, sex, race (Black or White), region ("stroke belt" or other), education, income, systolic blood pressure, body mass index, diabetes, coronary heart disease, hyperlipidemia, smoking, and albuminuria., Outcomes: (1) eGFR change and (2) incident CKD defined as eGFR<60mL/min/1.73m2 and≥40% decrease from baseline or kidney failure., Analytical Approach: Linear regression and modified Poisson regression were used to determine the association of risk factors with eGFR change and incident CKD overall and stratified by race, sex, and region., Results: Mean age of participants was 63±8 (SD) years, 54% were female, and 35% were Black. After 9.4±1.0 years of follow-up, CKD developed in 9%. In an age-, sex-, and race-adjusted model, Black race (β =-0.13; P<0.001) was associated with higher risk of eGFR change, but this was attenuated in the fully adjusted model (β=0.02; P=0.5). Stroke belt residence was independently associated with eGFR change (β =-0.10; P<0.001) and incident CKD (relative risk, 1.14 [95% CI, 1.01-1.30]). Albuminuria was more strongly associated with eGFR change (β of-0.26 vs-0.17; P=0.01 for interaction) in Black compared with White participants. Results were similar for incident CKD., Limitations: Persons of Hispanic ethnicity were excluded; unknown duration and/or severity of risk factors., Conclusions: Established CKD risk factors accounted for higher risk of incident CKD in Black versus White individuals. Albuminuria was a stronger risk factor for eGFR decrease and incident CKD in Black compared with White individuals. Living in the US stroke belt is a novel risk factor for CKD., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)- Published
- 2023
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19. Dietary fried fish intake increases risk of CVD: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study.
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Nahab, Fadi, Pearson, Keith, Frankel, Michael R, Ard, Jamy, Safford, Monika M, Kleindorfer, Dawn, Howard, Virginia J, and Judd, Suzanne
- Subjects
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FISH as food , *FOOD consumption , *MORTALITY , *CARDIOVASCULAR diseases , *MYOCARDIAL infarction , *STROKE , *MYOCARDIAL infarction risk factors , *CONFIDENCE intervals , *COOKING , *FISHES , *LONGITUDINAL method , *QUESTIONNAIRES , *FOOD portions , *SECONDARY analysis ,STROKE risk factors - Abstract
ObjectiveThe objective of the present study was to examine the relationship of dietary fried fish consumption and risk of cardiovascular events and all-cause mortality.DesignProspective cohort study among participants of the REasons for Geographic And Racial Differences in Stroke (REGARDS) study who resided in the USA.SettingThe primary outcome measures included the hazard ratios (HR) of incident CVD including first incident fatal or non-fatal ischaemic stroke or myocardial infarction and all-cause mortality, based on cumulative average fish consumption ascertained at baseline.SubjectsParticipants (n 16 479) were enrolled between 2003 and 2007, completed the self-administered Block98 FFQ and were free of CVD at baseline.ResultsThere were 700 cardiovascular events over a mean follow-up of 5·1 years. After adjustment for sociodemographic variables, health behaviours and other CVD risk factors, participants eating ≥2 servings fried fish/week (v. <1 serving/month) were at a significantly increased risk of cardiovascular events (HR=1·63; 95 % CI 1·11, 2·40). Intake of non-fried fish was not associated with risk of incident CVD. There was no association found with dietary fried or non-fried fish intake and cardiovascular or all-cause mortality.ConclusionsFried fish intake of two or more servings per week is associated with an increased risk of cardiovascular events. Given the increased intake of fried fish in the stroke belt and among African Americans, these data suggest that dietary fried fish intake may contribute to geographic and racial disparities in CVD. [ABSTRACT FROM AUTHOR]
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- 2016
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20. Blacks Are Less Likely to Present With Strokes During the COVID-19 Pandemic
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Christine A Holmstedt, Alejandro M Spiotta, Cori Cummings, Sami Al Kasab, and Eyad Almallouhi
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Advanced and Specialized Nursing ,South carolina ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.disease ,Pandemic ,Medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Buckle ,business ,Stroke ,Coronavirus Infections ,Stroke Belt ,Demography - Abstract
Background and Purpose: The impact of the coronavirus disease 2019 (COVID-19) pandemic on stroke systems has not been systematically evaluated. Our study aims to investigate trends in telestroke consults during the pandemic. Methods: We did retrospective chart review of consecutive patients seen through a telestroke network in South Carolina from March 2019 to April 2020. We dichotomized patients to preCOVID-19 pandemic (March 2019 to February 2020) and during COVID-19 pandemic (March to April 2020). Results: A total of 5852 patients were evaluated during the study period, 613 (10.5%) were seen during the pandemic. The median number of weekly consults dropped from 112 to 77 during the pandemic, P =0.002. There was no difference in baseline features; however, Black patients were less likely to present with strokes during the pandemic (13.9% versus 29%, P ≤0.002). Conclusions: The COVID-19 pandemic has led to a significant drop in telestroke volume. The impact seems to disproportionately affect Black patients.
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- 2020
21. The stroke mothership model survived during COVID-19 era: an observational single-center study in Emilia-Romagna, Italy
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Francesco Tagliatela, Laura Piccolo, Andrea Zini, Giovanni Gordini, Luigi Simonetti, Ludovica Migliaccio, Carlo Descovich, C Princiotta, Vincenzo Bua, Luigi Cirillo, Carlo Coniglio, Federica Naldi, Oscar Dell'Arciprete, Cosimo Picoco, Michele Romoli, Pietro Cortelli, Mauro Gentile, and Zini A, Romoli M, Gentile M, Migliaccio L, Picoco C, Dell'Arciprete O, Simonetti L, Naldi F, Piccolo L, Gordini G, Tagliatela F, Bua V, Cirillo L, Princiotta C, Coniglio C, Descovich C, Cortelli P.
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medicine.medical_specialty ,Neurology ,Epidemiology ,Pneumonia, Viral ,Clinical Neurology ,Dermatology ,Single Center ,Time-to-Treatment ,Transient ischemic-attack ,03 medical and health sciences ,Betacoronavirus ,0302 clinical medicine ,medicine ,Prevalence ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Stroke ,Pandemics ,Stroke Belt ,Neuroradiology ,Retrospective Studies ,Ischemic stroke . Transient ischemic-attack . Epidemiology . COVID-19 ,Ischemic stroke ,business.industry ,SARS-CoV-2 ,COVID-19 ,Retrospective cohort study ,General Medicine ,medicine.disease ,Psychiatry and Mental health ,Italy ,Emergency medicine ,Observational study ,Neurology (clinical) ,business ,Coronavirus Infections ,030217 neurology & neurosurgery - Abstract
Introduction A reduction of the hospitalization and reperfusion treatments was reported during COVID-19 pandemic. However, high variability in results emerged, potentially due to logistic paradigms adopted. Here, we analyze stroke code admissions, hospitalizations, and stroke belt performance for ischemic stroke patients in the metropolitan Bologna region, comparing temporal trends between 2019 and 2020 to define the impact of COVID-19 on the stroke network. Methods This retrospective observational study included all people admitted at the Bologna Metropolitan Stroke Center in timeframes 1 March 2019–30 April 2019 (cohort-2019) and 1 March 2020–30 April 2020 (cohort-2020). Diagnosis, treatment strategy, and timing were compared between the two cohorts to define temporal trends. Results Overall, 283 patients were admitted to the Stroke Center, with no differences in demographic factors between cohort-2019 and cohort-2020. In cohort-2020, transient ischemic attack (TIA) was significantly less prevalent than 2019 (6.9% vs 14.4%, p = .04). Among 216 ischemic stroke patients, moderate-to-severe stroke was more represented in cohort-2020 (17.8% vs 6.2%, p = .027). Similar proportions of patients underwent reperfusion (45.9% in 2019 vs 53.4% in 2020), although a slight increase in combined treatment was detected (14.4% vs 25.4%, p = .05). Door-to-scan timing was significantly prolonged in 2020 compared with 2019 (28.4 ± 12.6 vs 36.7 ± 14.6, p = .03), although overall timing from stroke to treatment was preserved. Conclusion During COVID-19 pandemic, TIA and minor stroke consistently reduced compared to the same timeframe in 2019. Longer stroke-to-call and door-to-scan times, attributable to change in citizen behavior and screening at hospital arrival, did not impact on stroke-to-treatment time. Mothership model might have minimized the effects of the pandemic on the stroke care organization.
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- 2020
22. Twenty Years of Progress Toward Understanding the Stroke Belt
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Virginia J. Howard and George Howard
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Advanced and Specialized Nursing ,medicine.medical_specialty ,Extramural ,business.industry ,Incidence (epidemiology) ,MEDLINE ,Infarction ,Stroke mortality ,medicine.disease ,Emergency medicine ,medicine ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke Belt - Published
- 2020
23. Evaluation of the Rapid Arterial oCclusion Evaluation (RACE) scale in Upstate South Carolina, USA.
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Thavarajah, Samadhi, Langston, Zachary, Sarayusa, Adam, Fowler, Lauren A., Sivakumar, Sanjeev, and Shah, Neel
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Objectives: Several stroke assessments have been designed for Emergency Medical Services to identify stroke patients with large vessel occlusion in the prehospital setting. The Rapid Arterial oCclusion Evaluation scale was developed in Spain, yet only few United States-based studies have confirmed findings from Spain. This study was designed to determine if the Rapid Arterial oCclusion Evaluation scale is a valid prehospital stroke assessment for identifying large vessel occlusion patients in South Carolina, USA.Materials and Methods: The performance of the Rapid Arterial oCclusion Evaluation scale was determined by calculating the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy at each score. The discriminative power of the Rapid Arterial oCclusion Evaluation score was evaluated using receiver operator characteristics. Comparison of the Rapid Arterial oCclusion Evaluation Scale to the National Institute of Health Stroke Scale was assessed using the Spearman's coefficient.Results: The Rapid Arterial oCclusion Evaluation scale had an acceptable discriminative power (c = 0.71). A score of ≥5 had a sensitivity of 0.71, specificity of 0.65, positive predictive value of 0.24, negative predictive value of 0.93, and accuracy of 0.66. There was a significant correlation between the Rapid Arterial Cclusion Evaluation score and the National Institute of Health Stroke Scale (rho = 0.60).Conclusion: The Rapid Arterial oCclusion Evaluation scale performed comparably to the National Institute of Health Stroke Scale in South Carolina; however, performed lower than Spain. Future studies should investigate patient demographics and emergency medical services training to determine if these variables contribute to the results found in this study. [ABSTRACT FROM AUTHOR]- Published
- 2022
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24. National Trends and Disparities in Hospitalization for Hypertensive Emergencies Among Medicare Beneficiaries, 1999–2019
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Khurram Nasir, Yuan Lu, Yun Wang, Fatima Rodriguez, Erica S. Spatz, Harlan M. Krumholz, Oyere Onuma, and Karol E. Watson
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education.field_of_study ,Hypertension control ,business.industry ,Mortality rate ,Population ,Medicare beneficiary ,medicine.disease ,Readmission rate ,medicine ,Hypertensive emergency ,National trends ,education ,business ,Stroke Belt ,Demography - Abstract
ImportanceIn the last two decades, hypertension control in the U.S. population has not improved, and there are widening disparities. Less is known, however, about progress in reducing hospitalizations related to hypertensive emergencies.ObjectivesTo describe trends in national hospitalization rates for hypertensive emergencies, overall and by demographic and geographical subgroups.Design, Setting and, ParticipantsSerial cross-sectional analysis of Medicare fee-for-service beneficiaries aged 65 years or older between 1999 and 2019 using Medicare denominator and inpatient files.Main Outcome and MeasuresTrends in hospitalization for hypertensive emergencies, overall and by specific subgroups.ResultsThe sample consisted of 397,238 individual Medicare fee-for-service beneficiaries. From 1999 through 2019, the annual hospitalization rates for hypertensive emergencies increased significantly from 51.5 to 125.9 per 100,000 beneficiary-years; this increase was most pronounced among the following subgroups: adults ≥85 years (66.8 to 274.1), females (64.9 to 160.1), Blacks (144.4 to 369.5), and Medicare-Medicaid insured (dual eligible, 93.1 to 270.0). Across all subgroups, Black adults had the highest hospitalization rate in 2019, and there was a significant increase in the differences in hospitalizations between Blacks and Whites from 1999 to 2019. Marked geographic variation was also present, with the highest hospitalization rates in the South (so-called “Stroke Belt”). Among 3,143 counties and county-equivalents included in the study, less than 1% of counties either had no change (n=7) or decreased (n=20) hospitalization rates since 1999. Among patients hospitalized for a hypertensive emergency, the observed 30-day all-cause mortality rate decreased from 2.6% to 1.7% and 30-day all-cause readmission rate decreased from 15.7% to 11.8%.Conclusions and RelevanceAmong Medicare fee-for-service beneficiaries aged 65 years or older, hospitalization rates for hypertensive emergencies increased substantially and significantly from 1999 to 2019. Black adults had the largest increase in hospitalization rates across age, sex, race, and dual-eligible strata. There was significant national variation, with the highest rates generally in the South.KEY POINTSQuestionHow have hospitalization rate for hypertensive emergencies among US adults aged 65 years and older changed between 1999 and 2019 and are there any differences across demographic and geographical subgroups?FindingsIn this serial cross-sectional study that included 397,238 individual Medicare fee-for-service beneficiaries, there was a marked increase in hospitalization rates for hypertensive emergencies from 1999 to 2019, and this increase was most pronounced among Black adults across age, sex, race, and dual-eligible strata. Significant national variation was observed, with the highest hospitalization rates generally in the South.MeaningBetween 1999 and 2019, hospitalization rates for hypertensive emergencies increased substantially and differences across demographic and geographic subgroups persisted.
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- 2021
25. An Examination of History for Promoting Diversity in Neuroscience
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M. Angele Theard
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Neuroanesthesia (D Sharma, Section Editor) ,Diversity ,business.industry ,media_common.quotation_subject ,Public policy ,Racism ,Health equity ,Disadvantaged ,Education ,Anesthesiology and Pain Medicine ,Anesthesiology ,Health care ,Medicine ,Health disparities ,business ,Neuroscience ,Inclusion (education) ,Stroke Belt ,media_common ,Diversity (politics) ,Perioperative care - Abstract
Purpose of Review A review of American history is presented to understand how public policy has contributed to a disproportionate burden of disease in members of underrepresented groups. A review of research conducted in the Stroke Belt provides an opportunity to examine more closely traditional and non-traditional risk factors in an effort to consider strategies for change. Recent Findings A diverse physician workforce has been offered as a way of improving care for our increasingly diverse populace. Given the expected increased prevalence of stroke in communities of color and the impact of stress from discrimination on health, proactive strategies to promote inclusion and equity to support diversity in perioperative neuroscience is warranted. Summary Public policy rooted in structural racism has left marginalized groups economically and educationally disadvantaged with less access to health care. Mistrust and fear from ongoing discrimination compels the neuroscience community to broaden their approach for developing a more reassuring and supportive educational environment for patients and trainees.
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- 2021
26. Performance of atherosclerotic cardiovascular risk prediction models in a rural Northern Chinese population: Results from the Fangshan Cohort Study
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Xun Tang, Jingrong Li, Pei Gao, Shaoping Huang, Hui-dong Dou, Yang Cao, Yonghua Hu, Na Li, Na Wu, Yaqin Si, Dudan Zhang, and Liu He
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Adult ,Male ,Rural Population ,China ,Population ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Risk prediction models ,Risk Assessment ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Humans ,Medicine ,030212 general & internal medicine ,education ,Stroke Belt ,Aged ,Aged, 80 and over ,Chinese population ,education.field_of_study ,Models, Statistical ,Atherosclerotic cardiovascular disease ,business.industry ,Middle Aged ,Cohort ,Female ,Population Risk ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Cohort study ,Demography - Abstract
Background Performance of Pooled Cohort Equations (PCEs) for atherosclerotic cardiovascular disease (ASCVD) risks varied across populations. Whether the recently developed Prediction for ASCVD Risk in China (China-PAR) model could accurately predict cardiovascular risks in real practice remains unclear. Methods A population-based cohort study in rural Beijing in the “stroke belt” in North China was used to externally validate PCE and China-PAR models for 5-year ASCVD risk prediction. Expected 5-year prediction risk using China-PAR model was compared with PCE (white). The models were assessed for calibration, discrimination, and reclassification. Results Among 11,169 adults aged 40 to 79 years over a median 6.44 years of follow-up, 1,921 participants developed a first ASCVD event during total 70,951 person-years. China-PAR model fairly predicted ASCVD risk in men but overestimated by 29.4% risk in women (calibration χ2 = 81.4, P Conclusions China-PAR outperformed PCE in 5-year ASCVD risk prediction in this rural Northern Chinese population at average population risk level, fairly predicted risk in men, but overestimated risk in women; however, China-PAR did not meaningfully improve the accuracy of discrimination and reclassification at individual risk level.
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- 2019
27. Dietary Patterns and Incident Heart Failure in U.S. Adults Without Known Coronary Disease
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Robert S. Rosenson, James M. Shikany, Suzanne E. Judd, Kyla M. Lara, Emily B. Levitan, Monika M. Safford, and Orlando M. Gutiérrez
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Adult ,Male ,medicine.medical_specialty ,Waist ,030204 cardiovascular system & hematology ,Lower risk ,Risk Assessment ,Severity of Illness Index ,White People ,Article ,Body Mass Index ,Cohort Studies ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Prospective cohort study ,Stroke Belt ,Aged ,Proportional Hazards Models ,Heart Failure ,business.industry ,Hazard ratio ,Age Factors ,Feeding Behavior ,Middle Aged ,Survival Analysis ,United States ,Confidence interval ,Diet ,Black or African American ,Hospitalization ,Quartile ,Female ,Factor Analysis, Statistical ,Cardiology and Cardiovascular Medicine ,business ,Body mass index - Abstract
Background Dietary patterns and associations with incident heart failure (HF) are not well established in the United States. Objectives The purpose of this study was to determine associations of 5 dietary patterns with incident HF hospitalizations among U.S. adults. Methods The REGARDS (REasons for Geographic and Racial Differences in Stroke) trial is a prospective cohort of black and white adults followed from 2003 to 2007 through 2014. Inclusion criteria included completion of a food frequency questionnaire and no baseline coronary heart disease or HF. Five dietary patterns (convenience, plant-based, sweets, Southern, and alcohol/salads) were derived from principal component analysis. The primary endpoint was incident HF hospitalization. Results This study included 16,068 participants (mean age 64.0 ± 9.1 years, 58.7% women, 33.6% black participants, 34.0% residents of the stroke belt). After a median of 8.7 years of follow-up, 363 participants had incident HF hospitalizations. Compared with the lowest quartile, the highest quartile of adherence to the plant-based dietary pattern was associated with a 41% lower risk of HF in multivariable-adjusted models (hazard ratio: 0.59; 95% confidence interval: 0.41 to 0.86; p = 0.004). Highest adherence to the Southern dietary pattern was associated with a 72% higher risk of HF after adjusting for age, sex, and race and for other potential confounders (education, income, region of residence, total energy intake, smoking, physical activity, and sodium intake; hazard ratio: 1.72; 95% confidence interval: 1.20 to 2.46; p = 0.005). However, the association was attenuated and no longer statistically significant after further adjusting for body mass index in kg/m2, waist circumference, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation, and chronic kidney disease. No statistically significant associations were observed with incident HF with reduced or preserved ejection fraction hospitalizations and the dietary patterns. No associations were observed with the other 3 dietary patterns. Conclusions Adherence to a plant-based dietary pattern was inversely associated with incident HF risk, whereas the Southern dietary pattern was positively associated with incident HF risk.
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- 2019
28. Stroke Belt birth state and late-life cognition in the Study of Healthy Aging in African Americans (STAR)
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Lisa L. Barnes, Rachel A. Whitmer, Elizabeth Rose Mayeda, Rachel Peterson, Charles DeCarli, M. Maria Glymour, Dan M Mungas, Kristen M George, and Paola Gilsanz
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Aging ,Epidemiology ,Overweight ,Cardiovascular ,Medical and Health Sciences ,Article ,Healthy Aging ,Social determinants of health ,Executive Function ,Cognition ,Cognitive dysfunction ,Clinical Research ,2.3 Psychological ,Behavioral and Social Science ,Medicine ,Semantic memory ,Humans ,Aetiology ,Cerebrovascular disease ,Episodic memory ,Socioeconomic status ,Birth Year ,Stroke Belt ,Heart disease risk factors ,Aged ,business.industry ,Minority health ,Neurosciences ,Middle Aged ,Confidence interval ,Brain Disorders ,Black or African American ,Stroke ,Cardiovascular diseases ,Mental Health ,Dementia ,Health status disparities ,medicine.symptom ,Alzheimer disease ,social and economic factors ,business ,Demography - Abstract
Purpose We examined the association of Stroke Belt birth state with late-life cognition in The Study of Healthy Aging in African Americans (STAR). Methods STAR enrolled 764 Black Americans ages 50+ who were long-term Kaiser Permanente Northern California members. Participants completed Multiphasic Health Check-ups (MHC; 1964–1985) where early-life overweight/obesity, hypertension, diabetes, and hyperlipidemia were measured. At STAR (2018), birth state, self-reported early-life socioeconomic status (SES), and executive function, verbal episodic memory, and semantic memory scores were collected. We used linear regression to examine the association between Stroke Belt birth and late-life cognition adjusting for birth year, gender, and parental education. We evaluated early-life SES and cardiovascular risk factors (CVRF) as potential mechanisms. Results Twenty-seven percent of participants were born in the Stroke Belt with a mean age of 69 (standard deviation = 9) at STAR. Stroke Belt birth was associated with worse late-life executive function (β [95% confidence interval]: −0.18 [−0.33, −0.02]) and semantic memory (−0.37 [−0.53, −0.21]), but not verbal episodic memory (−0.04 [−0.20, 0.12]). Adjustment for SES and CVRF attenuated associations of Stroke Belt birth with cognition (executive function [−0.05 {−0.25, 0.14}]; semantic memory [−0.28 {−0.49, −0.07}]). Conclusions Black Americans born in the Stroke Belt had worse late-life cognition than those born elsewhere, underscoring the importance of early-life exposures on brain health.
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- 2021
29. Abstract P695: Rural-Urban Differences in Functional Outcomes After Acute Therapy for Stroke
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Chen Lin, Jeffrey Z. Shen, Seeta Shah, Kimberly D. Martin, and Deepika Budhraja
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,Emergency medicine ,Medicine ,Neurology (clinical) ,Social determinants of health ,Stroke mortality ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Stroke ,Stroke Belt - Abstract
Introduction: The Southeastern United States, known as the “the stroke belt,” has the highest stroke mortality rate in the country. One possible reason is the high proportion of its residents living in rural areas. Studies suggest stroke care is worse for patients living in rural areas, and they are less likely to receive acute stroke therapy (intravenous thrombolysis or endovascular therapy), leading to worse outcomes. We compared 90-day modified Rankin Score (mRS) between patients living in urban versus rural areas who received acute stroke therapy. Methods: We performed a retrospective analysis of a tertiary care academic hospital in the Southeastern US, the University of Alabama at Birmingham. Patients admitted with imaging-confirmed ischemic stroke and had acute stroke therapy between 2014 and 2018 were included for analysis. Individuals were classified as rural or urban dwelling based on US Department of Agriculture’s 2010 Rural-Urban Commuting Area Codes. Clinical and demographic characteristics were collected from the chart. Stepwise logistic regression models were performed with these variables to compare good (mRS 0-1) vs poor (mRS 2-6) functional outcomes. Results: There were 232 patients included in the study (185 urban, and 47 rural). There were no significant differences between groups in age (urban 64.5±15.1; rural 66.2±14.7), gender (urban: 56% male 44% female, rural: 51% male 49% female), or proportion of African-Americans (33% of urban group and 25% of rural group). Mean baseline NIH stroke scale was higher in rural patients than urban (17.0 vs 14.8 respectively, p-value=0.03.). In logistical regression models for good functional outcome (mRS 0-1) at 90-days, analysis of factors including rural/urban status, gender, age, insurance, transfer, and acute stroke therapy, revealed only older age as a significant factor (OR 0.97, 95% CI 0.95-0.99). Conclusions: Our study demonstrated no significant differences in functional outcome between patients from urban and rural locations after receiving acute therapy for treating ischemic stroke. Importantly, only older age predicted poor functional outcome at 90 days. Our study demonstrates that patients from rural areas can recover similarly to those from urban areas.
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- 2021
30. Race and in-hospital mortality after spontaneous intracerebral hemorrhage in the Stroke Belt: Secondary analysis of a case–control study
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Logan D. Hilton, Toby Gropen, and Michael J Lyerly
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medicine.medical_specialty ,Population ,030204 cardiovascular system & hematology ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Hematoma ,Internal medicine ,medicine ,cardiovascular diseases ,Implementation, Policy and Community Engagement ,education ,Stroke ,race ,Stroke Belt ,disparities ,Intracerebral hemorrhage ,education.field_of_study ,ICH ,business.industry ,Glasgow Coma Scale ,Case-control study ,General Medicine ,Spontaneous intracerebral hemorrhage ,medicine.disease ,stroke ,business ,Re-engineering the Clinical Research Enterprise in Response to COVID-19: The CTSA Experience ,030217 neurology & neurosurgery ,Research Article - Abstract
Background and Purpose: Intracerebral hemorrhage (ICH) accounts for around 10% of stroke, but carries 50% of stroke mortality. ICH characteristics and prognostic factors specific to the Stroke Belt are not well defined by race. Methods: Records of patients admitted to the University of Alabama Hospital with ICH from 2017 to 2019 were reviewed. We examined the association of demographics; clinical and radiographic features including stroke severity, hematoma volume, and ICH score; and transfer status with in-hospital mortality and discharge functional status for a biracial population including Black and White patients. Independent predictors of in-hospital mortality and functional outcome were examined using logistic regression. Results: Among the 275 ICH cases included in this biracial analysis, Black patients (n = 114) compared to White patients (n = 161) were younger (60.6 vs. 71.4 years, P < 0.0001), more often urban (81% vs. 64%, P < 0.01), more likely to have a history of hypertension (87% vs. 71%, P < 0.01), less often transferred (44% vs. 74%, P < 0.01), and had smaller median initial hematoma volumes (9.1 vs. 12.6 mL, P = 0.041). On multivariable analysis, Glasgow Coma Scale (GCS) for White patients (OR 13.0, P < 0.0001), hyperlipidemia for Black patients (OR 13.9, P = 0.019), and ICH volume for either race (Black patients: OR 1.05, P = 0.03 and White patients: OR 1.04, P < 0.01) were independent predictors of in-hospital mortality. Conclusions: Hypertension is more prevalent among Black ICH patients in the Stroke Belt. The addition of hyperlipidemia to the ICH score model improved the prediction of mortality for Black ICH patients. No differences in in-hospital mortality or poor functional outcome were observed by race.
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- 2021
31. Correlates of a southern diet pattern in a national cohort study of blacks and whites: the REasons for Geographic And Racial Differences in Stroke (REGARDS) study
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Mary Cushman, James M. Shikany, Catharine Couch, Emily B. Levitan, George Howard, Neil A. Zakai, D. Leann Long, Suzanne E. Judd, Marquita S. Gray, Jennifer J. Manly, Leslie A. McClure, Virginia J. Howard, and Keith Pearson
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0301 basic medicine ,Adult ,Male ,Population ,Medicine (miscellaneous) ,Article ,National cohort ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Medicine ,Humans ,030212 general & internal medicine ,education ,Stroke ,Stroke Belt ,Aged ,education.field_of_study ,030109 nutrition & dietetics ,Nutrition and Dietetics ,business.industry ,Nutritional epidemiology ,Dietary pattern ,medicine.disease ,Diet ,Race Factors ,Black or African American ,Cohort ,Racial differences ,Female ,business ,Demography - Abstract
The Southern dietary pattern, derived within the REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort, is characterised by high consumption of added fats, fried food, organ meats, processed meats and sugar-sweetened beverages and is associated with increased risk of several chronic diseases. The aim of the present study was to identify characteristics of individuals with high adherence to this dietary pattern. We analysed data from REGARDS, a national cohort of 30 239 black and white adults ≥45 years of age living in the USA. Dietary data were collected using the Block 98 FFQ. Multivariable linear regression was used to calculate standardised beta coefficients across all covariates for the entire sample and stratified by race and region. We included 16 781 participants with complete dietary data. Among these, 34·6 % were black, 45·6 % male, 55·2 % resided in stroke belt region and the average age was 65 years. Black race was the factor with the largest magnitude of association with the Southern dietary pattern (Δ = 0·76 sd, P < 0·0001). Large differences in Southern dietary pattern adherence were observed between black participants and white participants in the stroke belt and non-belt (stroke belt Δ = 0·75 sd, non-belt Δ = 0·77 sd). There was a high consumption of the Southern dietary pattern in the US black population, regardless of other factors, underlying our previous findings showing the substantial contribution of this dietary pattern to racial disparities in incident hypertension and stroke.
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- 2021
32. High prevalence of obstructive sleep apnea syndrome in Spain’s Stroke Belt
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Ana Barragán-Prieto, Marta Ferrer, Pilar Algaba, Joan Montaner, Ana Domínguez-Mayoral, Reyes de Torres-Chacón, Carmen Yllera Gutierrez, José M. Benítez, Patricia Guerrero, Lidia Ruiz-Bayo, Soledad Pérez-Sánchez, Natalia Fouz-Rosón, María Aguilar, Miguel Ángel Gamero-García, Jesús Sanchez-Gómez, Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares (España), [Domínguez-Mayoral,A, Pérez-Sánchez,S, Gamero-García,MA, De Torres-Chacón,R, Barragán-Prieto,A, Ruiz-Bayo,L, Montaner,J] Stroke Unit, Neurology Department, Virgen Macarena University Hospital, Seville, Spain. [Sánchez-Gómez,J, Guerrero,P, Ferrer,M, Fouz-Rosón,N, Benítez,JM] Pneumology Department, Virgen Macarena University Hospital, Seville, Spain. [Gutiérrez,C, Aguilar,M] Neurophysiology Department, Virgen Macarena University Hospital, Seville, Spain. [Domínguez-Mayoral,A, Algaba,P, Montaner,J] Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain., and This work was supported by the Neurovascular Research Group, part of the Cooperative Cerebrovascular Disease Research Network (INVICTUS+) (RD16/0019/0015).
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Medicine (General) ,Prospective Clinical Research Report ,Pediatrics ,Estudios transversales ,Diseases::Nervous System Diseases::Sleep Disorders::Dyssomnias::Sleep Disorders, Intrinsic::Sleep Apnea Syndromes::Sleep Apnea, Central [Medical Subject Headings] ,Polysomnography ,Phenomena and Processes::Physiological Phenomena::Body Constitution::Body Weights and Measures::Body Size::Body Weight::Overweight::Obesity [Medical Subject Headings] ,Biochemistry ,Brain Ischemia ,Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings] ,Prevalence ,Medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Vital Statistics::Morbidity::Prevalence [Medical Subject Headings] ,Stroke ,Tamizaje masivo ,Persons::Persons::Age Groups::Adult::Aged [Medical Subject Headings] ,Health Care::Health Care Facilities, Manpower, and Services::Health Facilities::Hospitals [Medical Subject Headings] ,Psychiatry and Psychology::Psychological Phenomena and Processes::Psychophysiology::Sleep [Medical Subject Headings] ,Sleep Apnea, Obstructive ,Polisomnografía ,Ischemic stroke ,medicine.diagnostic_test ,Atrial fibrillation ,General Medicine ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cross-Sectional Studies [Medical Subject Headings] ,Spanish Stroke Belt ,Obstructive sleep apnea–hypopnea syndrome ,Hypertension ,Screening ,Parálisis facial ,Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke [Medical Subject Headings] ,medicine.medical_specialty ,Diseases::Nervous System Diseases::Neurologic Manifestations::Paralysis::Facial Paralysis [Medical Subject Headings] ,Polygraphy ,Síndromes de la apnea del sueño ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Physical Examination::Body Constitution::Body Weights and Measures::Body Mass Index [Medical Subject Headings] ,Diseases::Cardiovascular Diseases::Heart Diseases::Arrhythmias, Cardiac::Atrial Fibrillation [Medical Subject Headings] ,Diseases::Cardiovascular Diseases::Vascular Diseases::Hypertension [Medical Subject Headings] ,R5-920 ,Diseases::Nervous System Diseases::Sleep Disorders::Dyssomnias::Sleep Disorders, Intrinsic::Sleep Apnea Syndromes::Sleep Apnea, Obstructive [Medical Subject Headings] ,Hipertensión ,Humans ,Accidente cerebrovascular isquémico ,Stroke Belt ,Aged ,Geographical Locations::Geographic Locations::Europe::Spain [Medical Subject Headings] ,Ischemic cardiomyopathy ,Central Sleep Apnea Syndrome ,business.industry ,Biochemistry (medical) ,Apnea obstructiva del sueño ,Andalucía ,Cell Biology ,medicine.disease ,respiratory tract diseases ,Obstructive sleep apnea ,Cross-Sectional Studies ,Spain ,Diseases::Cardiovascular Diseases::Heart Diseases::Cardiomyopathies [Medical Subject Headings] ,Diseases::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Brain Ischemia [Medical Subject Headings] ,Prevalencia ,business ,Facial palsy ,Body mass index ,Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Neuroimaging [Medical Subject Headings] - Abstract
[Objective] Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain., [Methods] We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients, [Results] Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients., [Conclusions] The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS., The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by the Neurovascular Research Group, part of the Cooperative Cerebrovascular Disease Research Network (INVICTUS+) (RD16/0019/0015).
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- 2021
33. Racial and Sex Differences in the Response to First-Line Antihypertensive Therapy
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Seth T. Lirette, John S. Clemmer, and W. Andrew Pruett
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medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,hypertension ,medicine.drug_class ,Population ,Cardiovascular Medicine ,030204 cardiovascular system & hematology ,first line treatment ,03 medical and health sciences ,0302 clinical medicine ,black ,Internal medicine ,medicine ,030212 general & internal medicine ,cardiovascular diseases ,Antihypertensive drug ,education ,African American ,Socioeconomic status ,race ,antihypertensive therapy ,Stroke Belt ,Thiazide ,Original Research ,education.field_of_study ,business.industry ,Mortality rate ,Blood pressure ,lcsh:RC666-701 ,ACE inhibitor ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Objective: As compared to whites, the black population develops hypertension (HTN) at an earlier age, has a greater frequency and severity of HTN, and has poorer control of blood pressure (BP). Traditional practices and treatment efforts have had minor impact on these disparities, with over a 2-fold higher death rate currently for blacks as compared to whites. The University of Mississippi Medical Center (UMC) is located in the southeastern US and the Stroke Belt, which has higher rates of HTN and related diseases as compared to the rest of the country.Methods: We retrospectively analyzed the UMC's Research Data Warehouse, containing >30 million electronic health records from >900,000 patients to determine the initial BP response following the first prescribed antihypertensive drug.Results: There were 5,973 white (45% overall HTN prevalence) and 10,731 black (57% overall HTN prevalence) patients who met criteria for the study. After controlling for age, BMI, and drug dosage, black males were overall less likely to have controlled BP (defined as < 140/90 mmHg) and were associated with smaller falls in BP as compared to whites and black females. Blockers of the renin-angiotensin system (RAS) failed to significantly improve odds of HTN control vs. the untreated group in black patients. However, our data suggests that these drugs do provide significant benefit in blacks when combined with THZ, as compared to untreated and as compared to THZ alone.Conclusion: These data support the use of a single-pill formulation with ARB or ACE inhibitor with a thiazide in blacks for initial first-line HTN therapy and suggests that HTN treatment strategies should consider both race and gender. Our study gives a unique insight into initial antihypertensive responses in actual clinical practice and could have an impact in BP control efficiency in a state with prevalent socioeconomic and racial disparities.
- Published
- 2020
34. Identifying and assessing the impact of key neighborhood-level determinants on geographic variation in stroke: a machine learning and multilevel modeling approach
- Author
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Bian Liu, Liangyuan Hu, Jiayi Ji, and Yan Li
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Pooling ,Disease ,Machine learning ,computer.software_genre ,Disease cluster ,01 natural sciences ,Machine Learning ,010104 statistics & probability ,03 medical and health sciences ,0302 clinical medicine ,Residence Characteristics ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Stroke ,Stroke Belt ,Aged ,business.industry ,Neighborhood ,lcsh:Public aspects of medicine ,Prevention ,Multilevel model ,Public Health, Environmental and Occupational Health ,lcsh:RA1-1270 ,Bayes Theorem ,medicine.disease ,Bayesian machine learning ,Bayesian multilevel modeling ,Socioeconomic Factors ,Household income ,Artificial intelligence ,Biostatistics ,business ,computer ,Research Article - Abstract
Background Stroke is a chronic cardiovascular disease that puts major stresses on U.S. health and economy. The prevalence of stroke exhibits a strong geographical pattern at the state-level, where a cluster of southern states with a substantially higher prevalence of stroke has been called the stroke belt of the nation. Despite this recognition, the extent to which key neighborhood characteristics affect stroke prevalence remains to be further clarified. Methods We generated a new neighborhood health data set at the census tract level on nearly 27,000 tracts by pooling information from multiple data sources including the CDC’s 500 Cities Project 2017 data release. We employed a two-stage modeling approach to understand how key neighborhood-level risk factors affect the neighborhood-level stroke prevalence in each state of the US. The first stage used a state-of-the-art Bayesian machine learning algorithm to identify key neighborhood-level determinants. The second stage applied a Bayesian multilevel modeling approach to describe how these key determinants explain the variability in stroke prevalence in each state. Results Neighborhoods with a larger proportion of older adults and non-Hispanic blacks were associated with neighborhoods with a higher prevalence of stroke. Higher median household income was linked to lower stroke prevalence. Ozone was found to be positively associated with stroke prevalence in 10 states, while negatively associated with stroke in five states. There was substantial variation in both the direction and magnitude of the associations between these four key factors with stroke prevalence across the states. Conclusions When used in a principled variable selection framework, high-performance machine learning can identify key factors of neighborhood-level prevalence of stroke from wide-ranging information in a data-driven way. The Bayesian multilevel modeling approach provides a detailed view of the impact of key factors across the states. The identified major factors and their effect mechanisms can potentially aid policy makers in developing area-based stroke prevention strategies.
- Published
- 2020
35. Letter by Grant Regarding Article, 'Twenty Years of Progress Toward Understanding the Stroke Belt'
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William B. Grant
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Advanced and Specialized Nursing ,Stroke ,medicine.medical_specialty ,business.industry ,Family medicine ,MEDLINE ,Medicine ,Humans ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke Belt - Published
- 2020
36. Response by G. Howard and V.J. Howard to Letter Regarding Article, 'Twenty Years of Progress Toward Understanding the Stroke Belt'
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Virginia J. Howard and George Howard
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Advanced and Specialized Nursing ,medicine.medical_specialty ,business.industry ,MEDLINE ,medicine.disease ,Stroke ,Physical therapy ,Medicine ,Humans ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,Stroke Belt - Published
- 2020
37. Movement Matters, and So Does Context: Lessons Learned From Multisite Implementation of the Movement Matters Activity Program for Stroke in the Comprehensive Postacute Stroke Services Study
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Peter C. Coyle, Cheryl Bushnell, Amy M. Pastva, Anna M. Johnson, Janet K. Freburger, Sylvia W. Coleman, Compass Investigative Team, Karen M. Taylor, Wayne D. Rosamond, Pamela W. Duncan, Meghan D Radman, and Sara B. Jones
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030506 rehabilitation ,medicine.medical_specialty ,Evidence-based practice ,mmap ,Physical Therapy, Sports Therapy and Rehabilitation ,Context (language use) ,Health Promotion ,03 medical and health sciences ,0302 clinical medicine ,Acute care ,medicine ,North Carolina ,Humans ,Transitional care ,Exercise ,Stroke Belt ,Medical education ,Rehabilitation ,Health services research ,Stroke Rehabilitation ,Recovery of Function ,Transitional Care ,Implementation research ,0305 other medical science ,Psychology ,030217 neurology & neurosurgery ,Subacute Care ,Program Evaluation - Abstract
The purpose of this Special Communication is to discuss the rationale and design of the Movement Matters Activity Program for Stroke (MMAP) and explore implementation successes and challenges in home health and outpatient therapy practices across the stroke belt state of North Carolina. MMAP is an interventional component of the Comprehensive Postacute Stroke Services Study, a randomized multicenter pragmatic trial of stroke transitional care. MMAP was designed to maximize survivor health, recovery, and functional independence in the community and to promote evidence-based rehabilitative care. MMAP provided training, tools, and resources to enable rehabilitation providers to (1) prescribe physical activity and exercise according to evidence-based guidelines and programs, (2) match service setting and parameters with survivor function and benefit coverage, and (3) align treatment with quality metric reporting to demonstrate value-based care. MMAP implementation strategies were aligned with the Expert Recommendations for Implementing Change project, and MMAP site champion and facilitator survey feedback were thematically organized into the Consolidated Framework for Implementation Research domains. MMAP implementation was challenging, required modification and was affected by provider- and system-level factors. Program and study participation were limited and affected by practice priorities, productivity standards, and stroke patient volume. Sites with successful implementation appeared to have empowered MMAP champions in vertically integrated systems that embraced innovation. Findings from this broad evaluation can serve as a road map for the design and implementation of other comprehensive, complex interventions that aim to bridge the currently disconnected realms of acute care, postacute care, and community resources.
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- 2020
38. Abstract WP482: Early Life Exposure to the Stroke Belt and Later Life Incident Cognitive Impairment: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study
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Aleena Bennett, George Howard, Frederick W. Unverzagt, Virginia G. Wadley, Michael Crowe, Jennifer J. Manly, Leslie A. McClure, Virginia J. Howard, M. Maria Glymour, and Laura B. Zahodne
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Advanced and Specialized Nursing ,Gerontology ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,medicine.disease ,Early life ,Epidemiology ,medicine ,Residence ,Racial differences ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Cognitive impairment ,business ,Stroke ,Stroke Belt - Abstract
Introduction: Incidence of cognitive impairment is higher for residents of the Stroke Belt (SB) compared to those living outside it, but the importance of timing of SB residence is unclear. Methods: Participants were aged 45+ yrs, and enrolled in 2003-2007 in REGARDS. Cognition was assessed annually, by telephone, using the Six-Item Screener (SIS) in 11,488 black or white stroke-free participants currently living in the SB, and 8,949 currently living outside of the SB. Incident cognitive impairment was defined as SIS score of < 4 at last assessment among participants with initial SIS >4. Exposures were defined as SB residence all years, some years, or no years of childhood (ages 0-18) and early adulthood (ages 19-30). Demographic adjusted logistic regression models were stratified by SB residence at enrollment, and were used to estimate the demographic-adjusted odds of incident cognitive impairment. Results: Among those currently residing in the SB, childhood residence outside the SB for some (OR = 0.82; 95% CI: 0.68 - 0.99) or all (OR = 0.76; 95% CI: 0.65 - 0.90) of the time predicted lower odds of incident cognitive impairment. Similarly, early adulthood residence outside the SB for some (OR = 0.86; 95% CI: 0.74 - 0.98) or all (OR = 0.70; 95% CI: 0.58 - 0.84) of the time predicted lower incident cognitive impairment. Conversely, for those currently living outside the SB, the risk of incident cognitive impairment was higher for those who had spent their entire early adulthood in the SB (OR = 1.51; 95% CI: 1.01 - 2.57), with non-significant increased risk for childhood exposure or some early adulthood exposure to the SB (table). Conclusions: These findings suggest that early residence in the SB during childhood or early adulthood increases the risk of cognitive impairment regardless of place of residence in later adulthood. Further research is needed to determine the characteristics of early SB life that are linked to later adult cognitive impairment.
- Published
- 2020
39. Ideal telestroke time targets: Telestroke-based treatment times in the United States stroke belt
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Tina Benton, Conelia Williamson, Aliza T. Brown, Rohan Sharma, Sanjeeva Onteddu, William C. Culp, Tiffany Morgan, Nidhi Kapoor, Renee Joiner, Curtis L. Lowery, and Krishna Nalleballe
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Male ,Critical time ,medicine.medical_specialty ,Time Factors ,Thrombolytic treatment ,020205 medical informatics ,Stroke patient ,medicine.medical_treatment ,Health Informatics ,02 engineering and technology ,03 medical and health sciences ,0302 clinical medicine ,Fibrinolytic Agents ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Humans ,Thrombolytic Therapy ,030212 general & internal medicine ,Stroke ,Stroke Belt ,Aged ,Retrospective Studies ,Arkansas ,Ideal (set theory) ,business.industry ,Thrombolysis ,medicine.disease ,United States ,Tissue Plasminogen Activator ,Emergency medicine ,Female ,Tomography, X-Ray Computed ,business - Abstract
Background Studying critical time interval requirements can enhance thrombolytic treatment for stroke patients in telestroke networks. We retrospectively examined 12 concurrent months of targeted time interval information in the South Central US telemedicine programme, Arkansas Stroke Assistance through Virtual Emergency Support (AR SAVES). Hypothesis: We hypothesised that consult data analysis would highlight areas for improvement to shorten overall door to Intra venous (IV) tissue plasminogen activator (tPA) administration time. Methods We analysed critical time targets for 238 consecutive telestroke neurology consults obtained over 12 months from AR SAVES spoke sites when tPA was administered. The following time intervals were analysed: emergency department (ED) door to Computed Tomography (D-CT); ED door to call centre (D-CC) for initiation of consult; ED door to neurology call (D-NC); neurology call to camera (NC-Cam); tele consult time (Con); ED door to tissue plasminogen activator (tPA)/needle (DTN). Results The median times of D-CT (13 min, inter quartile range (IQR) 6–22 min), D-CC (34 min, IQR 20–45 min), D-NC (40 min, IQR 21–71 min), NC-Cam (4 min, IQR 2–8 min), and Con (25 min, IQR 17–37 min) all contributed to a DTN median time of 71 min (IQR 50–104 min). A total of 238 patients received tPA with a 29.4% treatment rate and a DTN time of ≤60 min was achieved in 25.2% of patients. Conclusions Focusing on reducing D-CC and Con times may help to achieve the DTN time of
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- 2018
40. Determinants of stroke prevalence in the southeastern region of the United States
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John D. Morgan, Michael Fazio, Courtney Cook, Peter Memiah, Kelechi Ibe-Lamberts, and Daudet Ilunga Tshiswaka
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medicine.medical_specialty ,Behavioral Risk Factor Surveillance System ,business.industry ,Stroke prevalence ,030503 health policy & services ,Public health ,Mortality rate ,Public Health, Environmental and Occupational Health ,Logistic regression ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Medicine ,030212 general & internal medicine ,0305 other medical science ,business ,Stroke ,Stroke Belt ,Demography - Abstract
The southeast of the United States (USA) is a high stroke prevalence area otherwise known as the “Stroke Belt” in order to characterize the increased stroke morbidity and mortality rates found there. The purpose of this study was to characterize the relationship between socio-cultural factors and dietary habits related to stroke occurrence within the affected states. The 2015 Behavioral Risk Factor Surveillance System (BRFSS) data was analyzed for both bivariate and multivariate models aimed at studying the interaction between socio-cultural factors and the prevalence pattern of stroke in the southeastern area of the USA. Overall, 4% of individuals who lived in the US southeastern states of Alabama, Florida, Georgia, Louisiana, and Mississippi had stroke. Of these, Mississippi had the most stroke victims, followed by Alabama, Louisiana, Georgia, and Florida, with 5.1%, 4.7%, 4.5%, 4.3%, and 3.4% respectively (χ2 = 18.68 and p value
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- 2018
41. 'Timing it Right': needs of African American adults with stroke and their caregivers across the care continuum
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Gayenell S. Magwood, Suzanne Perea Burns, and Barabara J Lutz
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Cultural Studies ,Gerontology ,Adult ,Psychological intervention ,Qualitative property ,Community integration ,03 medical and health sciences ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,parasitic diseases ,medicine ,Humans ,030212 general & internal medicine ,Stroke ,Stroke Belt ,Qualitative Research ,030505 public health ,Family caregivers ,Public Health, Environmental and Occupational Health ,Social Support ,Continuity of Patient Care ,medicine.disease ,Care Continuum ,Focus group ,United States ,Black or African American ,Caregivers ,0305 other medical science ,Psychology - Abstract
Objective: African Americans are disproportionately affected by stroke in the United States (US). The purpose of this study is to explore experiences, wants, and needs of African Americans with stroke and their family caregivers residing in the stroke belt across the care continuum using the 'Timing It Right' (TIR) framework as a conceptual guide.Design: We conducted a series of focus groups among 20 African Americans living with stroke and 19 family caregivers. Focus groups were audio-recorded and transcribed verbatim. For this secondary analysis, we coded qualitative data using the TIR framework.Results: Participants in this sample identified pre-stroke needs in addition to the TIR phases that span across the care continuum and into community living. We identified four important contextual factors and real-world conditions that operate in the background and influence the post-stroke needs of this specific population across the TIR framework: (1) religion, faith, and church, (2) healthcare delivery, (3) community, and (4) sentinel events.Conclusions: We propose a TIR model that expands upon the original TIR framework which includes factors important for consideration when developing and delivering community-based interventions among African Americans with stroke and family caregivers in the southeastern US.
- Published
- 2019
42. Smoking and Stroke in Appalachian Kentucky
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Dignan Mark, Kitzman Patrick, S Gutti Subhash, N Gutti Swathi, Rao Sujata, Athena Kheibari, and Grant Victor
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medicine.medical_specialty ,education.field_of_study ,Neurology ,Rehabilitation ,business.industry ,medicine.medical_treatment ,Public health ,Medical record ,Population ,medicine.disease ,medicine ,Rural area ,education ,business ,Stroke ,Stroke Belt ,Demography - Abstract
This project used a retrospective case series design to investigate factors associated with stroke in a rural area in Appalachian Kentucky. The south-eastern region of the U.S. is often referred to as the ‘stroke belt,’ and includes the Appalachian region of the state of Kentucky. Data were collected from medical records of patients from a neurology practice and regional hospital with a diagnosis of stroke from March 2012 through November 2015. Data were collected without personal identifiers and included demographic characteristics, stroke type, treatments received, and referrals for additional care including rehabilitation. Data from a total of 84 stroke cases diagnosed between March 2012 and November 2015 were included. Of the 84 cases, 46 (54.8%) were female and all but one was Caucasian. The distribution by race is consistent with the population of the region. The stroke cases ranged in age from 41 to 92 (M=66.3) and the age at stroke diagnosis ranged from 40 to 90 (M=65.7). Fourteen (16.7%) had evidence of a previous stroke at diagnosis. For smokers, the mean age at diagnosis was 62.7 for smokers while for non-smokers it was 67.5. The study reported smoking rates that were nearly three-times the national average, and the smokers in this study were found to have stroke onset approximately five-years earlier than non-smokers. The results from this case series support the need for further investigation on stroke prevalence and factors contributing to continued risk for stroke in Appalachia.
- Published
- 2018
43. Accuracy of Prehospital Identification of Stroke in a Large Stroke Belt Municipality
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Michael Frankel, Iasson Yi, Tolulope Oyewumi, Ibthial Alattas, Nee-Kofi Mould-Millman, Moges Ido, Arthur Yancey, Michael Colman, and Halea Meese
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Male ,Emergency Medical Services ,medicine.medical_specialty ,Georgia ,Databases, Factual ,Stroke patient ,Emergency Nursing ,03 medical and health sciences ,0302 clinical medicine ,parasitic diseases ,Humans ,Medicine ,Registries ,cardiovascular diseases ,Stroke ,Stroke Belt ,Aged ,Retrospective Studies ,business.industry ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,United States ,Emergency Medical Technicians ,Identification (information) ,Logistic Models ,Emergency medicine ,Emergency Medicine ,Female ,business ,030217 neurology & neurosurgery - Abstract
Strokes are a leading cause of morbidity and mortality in the United States, especially in the "stroke belt" of the southeast. Up to 65% of stroke patients access care by calling 9-1-1. The primary objective of this study is to measure the accuracy of emergency medical dispatchers (EMD) and paramedics, in the prehospital identification of stroke.The study was based at Grady Emergency Medical Services, which is Atlanta, Georgia's public emergency medical services (EMS) provider. A retrospective analysis of all medically related 9-1-1 calls to Grady EMS classified as "stroke" between January 1, 2012, and December 31, 2012 was performed. A database was created using deterministic linkage between records from Grady EMS, Grady Hospital Emergency Department (ED), and the Grady Hospital Stroke Registry. Patients excluded were less than 18 years of age, had previous or concurrent head injuries, were transferred from another inpatient facility, and/or had incomplete patient records in any one of the three databases. Descriptive analysis, linear regression, and logistic multivariable regression were performed to discover the accuracy of stroke identification and contributory prehospital factors.A total of 548 patients were included: 475 were transported with EMS impression of stroke and 73 with an impression other than stroke. The median age was 59 years, 87.4% were black, and 52.6% were female. Paramedics adhered to all seven elements of the Grady EMS stroke protocol in 76.4% (n = 363) of suspected stroke cases. Sensitivity and positive predictive value for paramedic stroke identification was 76.2% and 49.3%, respectively, and for EMD, was 48.9% and 24%, respectively. Identification of hemorrhagic strokes had a relatively lower sensitivity. Paramedics were more likely to positively identify strokes when the Cincinnati Prehospital Stroke Scale (CPSS) screen was positive, or when classified by EMD as stroke. Paramedics were less likely to identify stroke in female patients. Paramedics' diagnostic accuracy was similar regardless of their adherence to the EMS stroke care protocol.EMD and EMS personnel in a large city in the Southeastern United States, with high stroke prevalence, had a relatively high sensitivity in identifying acute stroke patients. Paramedic accuracy was augmented by positive CPSS screening and by EMD recognition of stroke.
- Published
- 2018
44. Historical Slavery and Modern-Day Stroke Mortality in the United States Stroke Belt
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Bruce Ovbiagele, Charles Esenwa, Mulugeta Gebregziabher, and Daudet Ilunga Tshiswaka
- Subjects
Adult ,Male ,media_common.quotation_subject ,Disease ,030204 cardiovascular system & hematology ,Disease cluster ,White People ,03 medical and health sciences ,0302 clinical medicine ,Economic inequality ,medicine ,Humans ,Stroke ,Stroke Belt ,Aged ,media_common ,Aged, 80 and over ,Advanced and Specialized Nursing ,Median income ,Enslavement ,business.industry ,Middle Aged ,medicine.disease ,Southeastern United States ,Black or African American ,Unemployment ,Female ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery ,Medical literature ,Demography - Abstract
In the United States, stroke incidence and related mortality have declined in the past half century.1,2 This drop is largely because of better recognition and control of modifiable cardiovascular disease risk factors.3,4 There remain significant racial disparities however, and studies and surveillance programs consistently show higher rates of stroke and stroke-related mortality in native born blacks when compared with non-Hispanic whites (NHW).5–9 Nowhere is this racial disparity more evident than in the stroke belt, an area in the Southeastern United States with disproportionately high rates of stroke.10–12 Although a higher prevalence of cardiovascular disease risk factors, specifically hypertension, diabetes mellitus, obesity, and cigarette smoking, account for much of the excess stroke risk, it remains unclear why these cardiovascular comorbidities, and other lifestyle-related risk factors, cluster in this region of the United States, particularly in blacks.13–15 Multiple explanations have been proposed, but the medical community has yet to offer a fully satisfactory explanation for what is driving stroke mortality in the ≈700 hot spot counties of the stroke belt.16 A clue is that these counties also have higher proportions of black residents and unemployment, as well as lower educational status, median income, and healthcare use.16 While often ignored in the medical literature, a history of slavery, and ongoing social segregation, racial discrimination, and economic inequality, provide a historical precedent for the phenotype of poor cardiovascular health observed in several predominantly black communities. Although many reports depict the racial disparities and skew in stroke risk factors in this region of the United States, a PubMed search using the words slavery, slave, stroke, stroke belt, and cardiovascular disease returned no relevant articles. Our goal is to review the historical evidence and test the strength of association …
- Published
- 2018
45. Leveraging Multimedia Patient Engagement to Address Minority Cerebrovascular Health Needs: Prospective Observational Study
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James C. Grotta, Elizabeth A. Noser, Anjail Sharrief, Jing Zhang, Mohammad H. Rahbar, Sandi Shaw, Sean I Savitz, Nneka L. Ifejika, and Andrew D Barreto
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Population ,Health Informatics ,community engagement ,Medicare ,computer.software_genre ,Health intervention ,Health care ,medicine ,Humans ,environmental justice ,education ,Stroke ,Stroke Belt ,Aged ,health disparities ,urban flooding ,Original Paper ,education.field_of_study ,Multimedia ,business.industry ,Hispanic or Latino ,Middle Aged ,medicine.disease ,stroke ,United States ,Health equity ,Black or African American ,Female ,Health education ,Patient Participation ,business ,computer ,Medicaid - Abstract
Background Social inequities affecting minority populations after Hurricane Katrina led to an expansion of environmental justice literature. In August 2017, Hurricane Harvey rainfall was estimated as a 3000- to 20,000-year flood event, further affecting minority populations with disproportionate stroke prevalence. The Stomp Out Stroke initiative leveraged multimedia engagement, creating a patient-centered cerebrovascular health intervention. Objective This study aims to address social inequities in cerebrovascular health through the identification of race- or ethnicity-specific health needs and the provision of in-person stroke prevention screening during two community events (May 2018 and May 2019). Methods Stomp Out Stroke recruitment took place through internet-based channels (websites and social networking). Exclusively through web registration, Stomp Out Stroke participants (aged >18 years) detailed sociodemographic characteristics, family history of stroke, and stroke survivorship. Participant health interests were compared by race or ethnicity using Kruskal-Wallis or chi-square test at an α=.05. A Bonferroni-corrected P value of .0083 was used for multiple comparisons. Results Stomp Out Stroke registrants (N=1401) were 70% (973/1390) female (median age 45 years) and largely self-identified as members of minority groups: 32.05% (449/1401) Hispanic, 25.62% (359/1401) African American, 13.63% (191/1401) Asian compared with 23.63% (331/1401) non-Hispanic White. Stroke survivors comprised 11.55% (155/1401) of our population. A total of 124 stroke caregivers participated. Approximately 36.81% (493/1339) of participants had a family history of stroke. African American participants were most likely to have Medicare or Medicaid insurance (84/341, 24.6%), whereas Hispanic participants were most likely to be uninsured (127/435, 29.2%). Hispanic participants were more likely than non-Hispanic White participants to obtain health screenings (282/449, 62.8% vs 175/331, 52.9%; P=.03). Asian (105/191, 54.9%) and African American (201/359, 55.9%) participants were more likely to request stroke education than non-Hispanic White (138/331, 41.6%) or Hispanic participants (193/449, 42.9%). African American participants were more likely to seek overall health education than non-Hispanic White participants (166/359, 46.2% vs 108/331, 32.6%; P=.002). Non-Hispanic White participants (48/331, 14.5%) were less likely to speak to health care providers than African American (91/359, 25.3%) or Asian participants (54/191, 28.3%). During the 2018 and 2019 events, 2774 health screenings were completed across 12 hours, averaging four health screenings per minute. These included blood pressure (1031/2774, 37.16%), stroke risk assessment (496/2774, 17.88%), bone density (426/2774, 15.35%), carotid ultrasound (380/2774, 13.69%), BMI (182/2774, 6.56%), serum lipids (157/2774, 5.65%), and hemoglobin A1c (102/2774, 3.67%). Twenty multimedia placements using the Stomp Out Stroke webpage, social media, #stompoutstroke, television, iQ radio, and web-based news reached approximately 849,731 people in the Houston area. Conclusions Using a combination of internet-based recruitment, registration, and in-person assessments, Stomp Out Stroke identified race- or ethnicity-specific health care needs and provided appropriate screenings to minority populations at increased risk of urban flooding and stroke. This protocol can be replicated in Southern US Stroke Belt cities with similar flood risks.
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- 2021
46. Association of duration of residence in the southeastern United States with chronic kidney disease may differ by race: the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.
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Plantinga, Laura, Howard, Virginia J., Judd, Suzanne, Muntner, Paul, Tanner, Rikki, Rizk, Dana, Lackland, Daniel T., Warnock, David G., Howard, George, and McClellan, William M.
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KIDNEY diseases , *RACIAL differences , *COHORT analysis , *HYPERTENSION , *DIABETES , *DISEASE prevalence , *ALBUMINURIA - Abstract
Background: Prior evidence suggests that longer duration of residence in the southeastern United States is associated with higher prevalence of diabetes and hypertension. We postulated that a similar association would exist for chronic kidney disease (CKD). Methods: In a national population-based cohort study that enrolled 30,239 men and women = 45 years old (42% black/58% white; 56% residing in the Southeast) between 2003 and 2007, lifetime southeastern residence duration was calculated and categorized [none (0%), less than half (>0-< 50%), half or more (=50-< 100%), and all (100%)]. Prevalent albuminuria (single spot urinary albumin:creatinine ratio of =30 mg/g) and reduced kidney function (estimated glomerular filtration rate <60 ml/min/1.73 m²) were defined at enrollment. Incident end-stage renal disease (ESRD) during follow-up was identified through linkage to United States Renal Data System. Results: White and black participants most often reported living their entire lives outside (35.7% and 27.0%, respectively) or inside (27.9% and 33.8%, respectively) the southeastern United States. The prevalence of neither albuminuria nor reduced kidney function was statistically significantly associated with southeastern residence duration, in either race. ESRD incidence was not statistically significantly associated with all vs. none southeastern residence duration (HR = 0.50, 95% CI, 0.22-1.14) among whites, whereas blacks with all vs. none exposure showed increased risk of ESRD (HR = 1.63, 95% CI, 1.02-2.63; PraceXduration = 0.011). Conclusions: These data suggest that blacks but not whites who lived in the Southeast their entire lives were at increased risk of ESRD, but we found no clear geographic pattern for earlier-stage CKD. [ABSTRACT FROM AUTHOR]
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- 2013
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47. An analysis of the link between strokes and soils in the South Carolina coastal plains.
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Ducey, Thomas F., Miller, Jarrod O., Busscher, Warren J., Lackland, Daniel T., and Hunt, Patrick G.
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ENVIRONMENTAL exposure , *STROKE , *SOIL microbiology , *COASTAL plains , *EPIDEMIOLOGY , *GEOLOGICAL statistics - Abstract
The Stroke Belt is a geographical region of the Southeastern United States where resident individuals suffer a disproportionately higher rate of strokes than the rest of the population. While the “buckle” of this Stroke Belt coincides with the Southeastern Coastal Plain region of North and South Carolina and Georgia, there is a paucity of information pinpointing specific causes for this phenomenon. A number of studies posit that an exposure event–potentially microbial in nature–early in life, could be a risk factor. The most likely vector for such an exposure event would be the soils of the Southeastern Coastal Plain region. These soils may have chemical and physical properties which are conducive to the growth and survival of microorganisms which may predispose individuals to stroke. To this aim, we correlated SC stroke mortality data to soil characteristics found in the NRCS SSURGO database. In statewide comparisons, depth to water table (50 to 100 cm, R = 0.62) and soil drainage class (poorly drained, R = 0.59; well drained, R = −0.54) both showed statistically significant relationships with stroke rate. In a 20 county comparison, depth to water table, drainage class, hydric rating (hydric soils, R = 0.56), and pH (very strongly acid, R = 0.66) all showed statistically significant relationships with stroke rate. These data should help direct future research and epidemiology efforts to pinpoint the exact exposure events which predispose individuals to an increased stroke rate. [ABSTRACT FROM AUTHOR]
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- 2012
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48. Geographic Distribution of Dementia Mortality Elevated Mortality Rates for Black and White Americans by Place of Birth.
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Glymour, M. Maria, Kosheleva, Anna, Wadley, Virginia G., Weiss, Christopher, and Manly, Jennifer J.
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The article presents a study which investigates the stroke and dementia mortality rates among African Americans and White Americans born in the U.S. Stroke Belt (SB) states. National mortality records were linked with population data to calculate cause-specific mortality rates in 2000. It was found that states with higher stroke mortality have higher risk of Alzheimer's Disease (AD) mortality rates. It adds that dementia mortality rates have similar geographic patterns as stroke mortality.
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- 2011
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49. Enhancing the Effectiveness of Community Stroke Risk Screening: A Randomized Controlled Trial.
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Anderson, Roger T., Camacho, Fabian, Iaconi, Ala I., Tegeler, Charles H., and Balkrishnan, Rajesh
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Stroke risk factors are routinely assessed in community screening programs; however, the rate of patient follow-up for health care once risk factors are identified is known to be low. This study was conducted to test the effectiveness of a brief behavioral telephonic intervention in an ongoing community stroke prevention screening program on health care seeking for stroke risk. A total of 227 participants with 2 or more stroke risk factors were randomly allocated to either an attention control arm or a behavioral intervention arm. The control group received standard information on risk and advice, whereas the intervention group received a brief Health Belief Model telephonic intervention designed to motivate care-seeking. The effect of treatment on the participants who completed a health care visit for stroke risk concerns was assessed using logistic regression. Cox survival analysis was used to compare time to physician visit between the 2 groups. Participants in the intervention arm were 1.85 times more likely to visit a primary care physician than controls. At 3 months, 69.2% of subjects in the intervention arm and 52.9% of those in the controls arm reported a new primary care visit after screening (P = .02), with 56.0% in the intervention arm and 38.4% in the control arm reporting a primary care visit specifically to discuss the stroke screening results (P < .01). Our data indicate that the brief, low-cost, motivational intervention effectively promoted adherence to screening advice and merits further testing. [Copyright &y& Elsevier]
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- 2011
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50. Abstract No. 550 The impact of stay-at-home orders on code stroke activations and mechanical thrombectomy
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A. Hines, Eric A. Wang, D. Strong, J. Rhoten, and T. Prasad
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medicine.medical_specialty ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,business.industry ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,medicine.disease ,Mechanical thrombectomy ,Internal medicine ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Stroke incidence ,business ,Stroke ,Stroke Belt ,Large vessel occlusion - Abstract
Purpose: Stay-at-home orders and additional fears of the COVID-19 pandemic led to a decrease in the presentation of patients with stroke symptoms in emergency departments across some regions in the U.S. but without a similar decline in mechanical thrombectomy (MT) (1). However, a significant decrease of MT cases was observed in other countries such as France (2). It is unknown if the same phenomenon was observed across the entire U.S. The purpose of this study was to review the volumes of code stroke activation, emergent large vessel occlusion (ELVO) activation, and MT cases in a Stroke Belt region during statewide stay-at-home measures to determine if the percentage of ELVO and MT cases to all code stroke activations were equally affected. Materials and Methods: We retrospectively reviewed hospital data for code stroke activations, code stroke activations for large vessel occlusion (LVO), and MT cases for the 53-day stay-at-home ordinance in North Carolina (March 30 to May 22, 2020). This data set was compared to the two preceding (Dec 14, 2019 to March 29, 2020) and two following (May 23, 2020, to September 5, 2020) 53-day time periods. Results: Code stroke activation volumes during the preceding two 53-day periods leading up to the stay-at-home ordinance were 857 and 785 but significantly decreased to 632 during the statewide stay-at-home orders (P < 0.01);this was a 23% reduction in volume compared to the mean of the two prior periods. All activations then rebounded to baseline levels (890, 886) in the two time periods after lifting stay-at-home orders. Similar decreases were noted for ELVOs and MTs during the stay-at-home time period as there was no significant change in the percentage of ELVO activations per all stroke activations (9.6%, P = 0.50) and cases that ultimately underwent thrombectomy (5.7%, P = 0.80) when compared to both the mean of the prior two 53-day time periods (8.4%, 5.3%, respectively) and the subsequent two respective time periods (9.0%, 4.8%, respectively). Conclusions: In our large catch-basin metropolitan region within the Southeast stroke belt, there was an overall and similar percentage decline in all code stroke activations, ELVO activations, and MT cases during the implementation of statewide mandatory stay-at-home orders. The data suggests that patients were either deferring care during stay-at-home orders despite the severity of symptoms, or there was an actual decline in stroke incidence across all severities in our region during this time period.
- Published
- 2021
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