Racial residential segregation and stroke mortality in Atlanta.

OBJECTIVE To assess the association between neighborhood-level racial residential segregation and stroke mortality using a spatially derived segregation index. DESIGN Cross-sectional study SETTING Atlanta Metropolitan Statistical Area METHODS The study population consisted of non-Hispanic Black and White residents of the Atlanta Metropolitan Statistical Area during the time period Jan 1, 2000 to December 31, 2006. Census tract-level stroke death rates for Blacks and Whites were modeled as a function of the segregation index while controlling for two neighborhood-level chronic stressors (poverty, low education). RESULTS Racial segregation was positively associated with stroke mortality for both Blacks and Whites aged 35-64 years. Among Blacks and Whites aged 65 or older, segregation was negatively associated with stroke mortality after controlling for the two stressors, suggesting that they were pathways between segregation and stroke death rates. CONCLUSION Future studies are needed to identify additional pathways between residential segregation and other health outcomes, and to collect data that support a life course approach to understanding the impact of residential segregation on health.