Decline in US stroke mortality - An analysis of temporal patterns by sex, race, and geographic region

Background and Purpose-Although stroke mortality rates have declined rapidl y over the past 30 years, the decline has slowed to a plateau. Here, we ass ess whether the race-sex-region groups have participated equally in this de cline and whether there are groups in which stroke mortality rates are stil l declining, and we predict how these rates will eventually differ. Methods-Data on stroke mortality in the United States between 1968 and 1996 were analyzed in a 3-step procedure: (1) we calculated "crude" age-adjuste d stroke mortality rates by race, sex, and county; (2) we "smoothed" the ra tes across counties and years; and (3) we fit a model to describe the tempo ral pattern. From this model we calculated the percent decline in stroke mo rtality, the anticipated additional decline (thereby identifying regions th at will continue to decline), and the anticipated eventual stroke mortality rates. Results-Maps by race-sex-region group describe the above parameters. White men have experienced the largest decline in stroke mortality, and black men have seen the smallest. Generally, stroke mortality appears to still be sl owly declining for blacks but not for whites. Geographic differences in str oke mortality are predicted to persist. Conclusions-The analysis suggests that the Deep South (Alabama and Mississi ppi) will fall from the stroke belt and be replaced by other regions (notab ly Oregon, Washington, and Arkansas). New York City and southern Florida ha d low stroke mortality rates in 1968, have experienced large declines, and continue to experience declines, resulting in even larger relative heteroge neity of stroke mortality rates. The reasons for these differences in the p attern of the decline in stroke mortality are not understood.