Living in the ‘stroke belt’



I have a friend who is considerably younger than I am.  She is not overweight, not does she smoke.  I was shocked to learn she suffered a severe stroke several years ago, and is still suffering from some of the after-effects.

Naturally I was stunned to learn that those of us living in the Southeast are at greater risk than the rest of the nation. That made no sense to me at first.

Take a look at a map showing the incidence of strokes across the United States, and you’ll see a surprisingly dense cluster in the southeast. Americans living in this region have a 15-percent higher stroke risk, and the death rate from stroke in these "stroke belt" states is 30 to 40 percent higher than in the rest of the country.

Does this mean that if you live in this area you have to move to escape your stroke risk? No, but it does mean that you should be sure to escape the cultural trap of unhealthy behaviors, like a poor diet and smoking that can drastically increase your stroke risk.

The Stroke Belt: States Affected

The stroke belt concept is "this big swath of southern and southeastern states where stroke just seems to be more common," says Stephen Page, PhD, rehabilitation researcher and assistant professor in the Physical Medicine and Rehabilitation Department at the University of Cincinnati Academic Medical Center in Ohio.

The specific stroke belt states are North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas, and Louisiana.

The Stroke Belt: Lifestyle Risks

To try to understand why stroke risk is greater in the stroke-belt states than in other areas of the country, researchers are looking at the lifestyle factors that play a role to see how prevalent they are in those states.

Smoking. Dr. Page points out, “Smoking and that whole class of unhealthy behaviors may be more common in those areas. They are tobacco [producing] states, and there are places in the south where smoking is more common, and high blood pressure and diabetes are higher."

Diet and genetics. "Diet and genetics can certainly play a role; genetics can interact with nutrition. Nutrition can actually change the way your genes are expressed,” Page explains. The "southern" diet of fried chicken, fried vegetables, fried potatoes, and fried everything else may contribute to the problem. “Also lifestyle — in many of these states, exercise and healthy behaviors aren’t as common," adds Page.

Access to care. This may also be an issue, according to Page. People living in rural areas may not be able to easily get to a doctor for treatment, or doctors may not have the experience, medications, and tests needed to properly diagnose and treat a stroke. These factors could possibly contribute to the increased mortality rate of strokes in the stroke belt states.

"The ‘stroke belt’ has persisted, and it continues to show an increased mortality. Some of it may be ethnic differences, but not all of it," says Ralph L. Sacco, MD, neurologist-in-chief at Jackson Memorial Hospital in Miami, Fla., and spokesperson for the American Stroke Association. "It’s been a bit of a puzzle."


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