Stroke mortality disparities in the population of the Appalachian Mountain region.

OBJECTIVES: Racial and rural-urban differences in stroke were previously reported in demographically and socioeconomically heterogeneous populations. However, it is not clear whether they exist in more homogeneous populations. Compared to the rest of the United States, the Appalachian region is highly rural and more homogeneous, with a predominantly White and socioeconomically disadvantaged population. The goal of our study was to investigate whether racial disparities in stroke mortality exist among the Appalachian population. DESIGN, SETTING, PARTICIPANTS: Patterns of stroke mortality for a seven-year period (2000-2006) were investigated in the Appalachian adult population of > or = 25 years. Data on stroke deaths were obtained from the Centers for Disease Control and Prevention, National Center for Health Statistics. Multivariable Poisson regression models were used to estimate adjusted relative risks (RR), adjusting for confounding factors. MAIN OUTCOME MEASURE: Stroke death rates. RESULTS: Stroke mortality in Appalachia was 20.5% higher than outside Appalachia (96.67 and 80.25 per 100,000 person-years, P < .001). Stroke mortality was statistically significantly higher in African Americans than in other racial groups: Caucasians (adjusted RR = 1.428, P < .001), Asians (adjusted RR = 2.821, P < .001), and Native American Indians (adjusted RR = 3.571, P < 0.001). Rural-urban stroke mortality disparities were statistically significant outside Appalachia but not within Appalachia. CONCLUSIONS: Racial disparities in stroke mortality exist in the Appalachian region. Further studies are warranted to investigate the rationale for possible health policy interventions and socioeconomic measures.