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| Is the "Stroke Belt" worn from childhood? |
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September 2007
The "stroke belt" is a region in the south-eastern United States with a concentration of high stroke mortality rates. Most “Stroke Belt studies” define exposure based on residence at stroke onset. A recently published study assessed whether residence in the Stroke Belt during childhood confers extra stroke risk in adulthood, even among people who left the region.
Maria Glymour, ScD, from the Department of Society, Human Development, and Health (M.M.G., L.F.B.), Harvard School of Public Health, Boston, and her colleagues classified Stroke-free Health and Retirement Study participants (n=18,070) followed up (average, 8.4 years) for first stroke (1452 events) as living in 1 of 7 Stroke Belt states in childhood or at study enrolment (average age, 63 years). The investigators used Cox proportional hazards models to compare the stroke risk for people who had never lived in the Stroke Belt with those who had lived there at both ages, in childhood only, or in adulthood only.
The authors found that compared with never having lived in the Stroke Belt, the hazard ratio of stroke for Stroke Belt residence in both childhood and adulthood was 1.23 and for Stroke Belt residence in childhood only was 1.25. Stroke Belt residence at enrollment but not during childhood was not significantly related to stroke risk, but the small sample in this group resulted in wide confidence intervals.
Results changed little after risk factor adjustment, including comprehensive adult socioeconomic measures. Subgroup analyses found similar patterns by sex and birth cohort. In contrast, blacks who had lived in the Stroke Belt in childhood only did not appear to have significantly elevated stroke risk compared with blacks who had never lived in the Stroke Belt.
The authors concluded that the excess stroke risk for people who had lived in Stroke Belt states during childhood implicates early life exposures in the aetiology of the Stroke Belt.
Reference:
Stroke 2007; 38 (9): 2414–2421.
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