Reassessing the Stroke Belt

The stroke belt, an 8-state region in the southeastern United States, defined for its disproportionately high stroke mortality rates, has been present since at least 1940 and persists despite recent decreases in stroke mortality, overall. Differences in vascular risk factors may explain approximately half of the excess burden, yet underlying drivers in this region are not fully understood. Access to primary stroke centers (PSCs) is lower within the region, suggesting that differential access to care could be one contributing factor. Using the existing state-based definition may not provide adequate geographic precision to fully understand the impact of local demographic and healthcare factors as determinants of health. We used county-level data and spatial statistics to empirically identify geographic clusters of high stroke mortality, or hot spots, at a finer geographic resolution to compare with the traditional state-based stroke belt. We compared multiple county-level variables between high stroke mortality hot spots and adjacent low stroke mortality cool spots, to understand local factors contributing to stroke outcomes.