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Death Rates for Stroke per 100,000
Population Groups Defined
by Race, Age, and Gender: 1993
It is apparent that the stroke
death rate for specified age groups in 1993 was higher for
African-American men and women than it was for Caucasian men
and women. The ratio of age-adjusted death rates for
African Americans as compared to Caucasians (all genders)
was 1.49.
The National Health and Nutrition
Examination Survey I: Epidemiologic Follow-Up Study (NHEFS)
compared mortality rate ratios of African-American versus
Caucasian persons, aged 35 through 77 years, before and after
adjustment for different risk factors [Otten MW, et at. JAMA.
1990;263:845]. The overall age-adjusted mortality rate
ratio (African Americans/Caucasians) was 1.32. The ratio
for death due to stroke was 1.98, making stroke the disease
category that accounted for the greatest percent difference
in mortality rate between two populations. The data
suggested that 31% of the total excess mortality in African
Americans (age 35-45) could be accounted for by known risk
factors for cardiovascular disease (smoking, systolic blood
pressure, cholesterol level, body-mass index, alcohol intake,
and diabetes); a further 38% could be accounted for by family
income, leaving 31% of the excess African-American total mortality
unexplained. The association between family income and
excess mortality was not fully unexplained, but the investigators
suggested that some of the increased prevalence of high blood
pressure and overweight may be a reaction to the "stresses
of being poor." Although lack of health care access
could be a factor, some data have indicated that poverty carried
excess mortality risks that were largely unexplained unequal
health care or social networks [Haan M, et al. Am J Epidemiol.
1987;125:989].
The epidemiology of stroke among
Hispanics in the United States has only begun to be investigated.
A study examining data from the National Center for Health
Statistics found that stroke mortality rates were similar
in Hispanic-Americans and other Caucasian populations aged
45 to 64 years; at ages 65 and over, Hispanics had rates that
were substantially lower [Gillum RF. Stroke 1995;26:1701-12].
It is suggested that ethnic differences in stroke mortality
may be due in part to lower blood pressure in Hispanics than
non-Hispanics.
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Stroke Education
