Stroke kills more black men than white men, especially in the southern states of the U.S., researchers say.

For example, in South Carolina, African-American men are almost four times more likely to die from a stroke (search) than white men.

A black man living almost anywhere in the south increases his risk for dying from a stroke by 51 percent compared with a black man living elsewhere, says George Howard, DrPH, professor and chair of the department of biostatistics, University of Alabama at Birmingham School of Public Health.

Howard is one of several stroke researchers who identified the so-called stroke belt — a wide region that sweeps across several states in the South. In those states both the number of strokes and the number of stroke deaths is significantly higher than it is in other parts of the country.

Howard, who presented the findings at the American Stroke Association's International Stroke Conference 2005, tells WebMD that he has no solid answers to explain the north-south difference in stroke deaths, but he has some theories.

He says, for example that “diabetes, high blood pressure, and low socioeconomic status are three big drivers of stroke risk.” These are all more common among blacks than whites.

Or, he says, it may be that there are some aspects of southern culture and lifestyle that increase the risk. “I think it is likely to be a combination of factors, but we won’t know until we have more data,” he says.

“African-Americans are known to be a high-risk group and my suspicion is that African-Americans living in the south may not be addressing risk factors as well as they are in other areas of the country,” Robert A. Felberg, MD, tells WebMD.

Felberg, who wasn’t involved in Howard’s study, says that “smoking is more prevalent in the South and there is a greater tendency toward obesity, and diets are high in saturated fats. I think all of these are likely to contribute to the differences these researchers are reporting.” Felberg is stroke program director in the department of neurology at the Ochsner Clinic Foundation (search) in New Orleans.

The report, he says, is a wake-up call for both doctors and patients to aggressively target risk factors by controlling blood pressure and diabetes, and promoting smoking cessation and exercise programs.

The Stroke Belt

Howard’s team looked at stroke death rates from 1997 through 2001. They compared the findings in the southern states that make up the “stroke belt” to nonsouthern states with large black populations: California, Illinois, Indiana, Maryland, Michigan, New Jersey, New York, Ohio, and Pennsylvania.

The stroke belt consists of Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee plus Florida and Virginia.

“Stroke deaths are lowest in New York,” Howard says. “That’s true for blacks and whites. Another interesting finding is that stroke deaths are also low in Miami, but in the panhandle area of Florida the numbers are similar to that in the rest of the south.”

The racial differences in stroke risk are most pronounced between the ages of 45 and 64, he says. Not surprisingly, given the fact that stroke risk increases with age, by 85 there were no significant differences in stroke deaths between blacks and whites.

The average stroke death rate for white men aged 55-64, living in the south, was 29 percent higher than white men not living in the south, Howard says. For black men of the same age, the stroke death rate in the south was 51 percent higher than the death rate in other regions.

The take-home message, says Howard, is a sobering one: Stroke can be deadly and ignoring risk factors — blood pressure, obesity, diabetes, smoking — only increases stroke’s deadly potential.

“That message is true for everyone, but it is particularly urgent for people living in the south,” he says.

By Peggy Peck, reviewed by Michael W. Smith, MD

SOURCES: “Regional Differences in the Increased Stroke Mortality of African Americans: The Remarkable Stroke Burden of Being a Southern African American,” American Stroke Association’s International Stroke Conference 2005, New Orleans, Feb. 2-5, 2005. George Howard, DrPH, professor; and chair, department of biostatistics, University of Alabama at Birmingham School of Public Health. Robert A. Felberg, MD, stroke program director, department of neurology, Ochsner Clinic Foundation, New Orleans.