GEOGRAPHIC-VARIATION IN THE DECLINE OF STROKE MORTALITY IN THE UNITED-STATES

Background and Purpose This study examines the geographic variation in the decline of stroke mortality rates in the United States. Methods N ational Center for Health Statistics and Bureau of the Census data wer e used to assess regional and state level temporal trends of stroke mo rtality in the United States for 1970 to 1989. Results Underlying- and multiple-cause stroke mortality rates have declined fairly steadily i n all regions of the United States and for all race/sex groups, althou gh the rates of decline were greater during 1970 to 1978 than during 1 979 to 1989. The declines in underlying-cause rates could not be attri buted to a shift toward reporting stroke as a contributing rather than underlying cause of death, since both underlying- and multiple-cause rates declined similarly. There was significant regional variation in the rate of decline, particularly during 1979 to 1989. The South initi ally had the highest rates, but it experienced the most rapid decline, so that by 1989 the South no longer had the highest rates. States wit h the most rapid rates of decline were significantly clustered in the South and particularly the Southeast. Most of the decline in overall s troke mortality was due to declines in ischemic stroke mortality. Conc lusions During 1970 to 1989 there was significant geographic variation in the rate of decline of stroke mortality rates, with the most rapid rates of decline concentrated in the high-rate areas of the South and particularly the Southeast. As a result, there has been a decrease in interregional and interstate variation in stroke mortality rates, whi ch is apparently not due to an artifact of changing reporting patterns .