Article

An approach to coordinate efforts to reduce the public health burden of stroke: the Delta States Stroke Consortium.

School of Public Health, University of Alabama at Birmingham, 35294-0022, USA.
Preventing chronic disease (Impact Factor: 1.82). 11/2004; 1(4):A19.
Source: PubMed

ABSTRACT Stroke is the third leading cause of death and a leading cause of disability in the United States, with a particularly high burden on the residents of the southeastern states, a region dubbed the "Stroke Belt." These five states - Alabama, Arkansas, Louisiana, Mississippi, and Tennessee - have formed the Delta States Stroke Consortium to direct efforts to reduce this burden. The consortium is proposing an approach to identify domains where interventions may be instituted and an array of activities that can be implemented in each of the domains. Specific domains include 1) risk factor prevention and control; 2) identification of stroke signs and symptoms and encouragement of appropriate responses; 3) transportation, Emergency Medical Services care, and acute care; 4) secondary prevention; and 5) recovery and rehabilitation management. The array of activities includes 1) education of lay public; 2) education of health professionals; 3) general advocacy and legislative actions; 4) modification of the general environment; and 5) modification of the health care environment. The Delta States Stroke Consortium members propose that together these domains and activities define a structure to guide interventions to reduce the public health burden of stroke in this region.

0 Bookmarks
 · 
196 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: We were interested in determining the rates of hypertension awareness, treatment, and control in individuals living in the southeastern United States and evaluating the impact of lifestyle behaviors on these rates. This is a cross-sectional survey of a sample of community dwellers in the greater Columbia, South Carolina area. The survey was developed from validated community-based survey questionnaires to evaluate demographic and social history (age, gender, race-ethnicity, income, and education), hypertension history (diagnosis and treatment), and lifestyle behavior (servings of fruits and vegetables [FV] and physical activity [PA] duration and frequency), as well as blood pressure measurement. A total of 763 people (mean +/- standard error age 52.4 +/- 0.7 years; 68% women, 53% African American) agreed to be screened. Of all participants with hypertension (438 [58%]), 82% were aware of their illness and 79% were on treatment. Of all hypertensive participants, 39% had their hypertension controlled below 140/90 mm Hg at the time of the survey. Only 11% reported consuming five or more FV per day and 18% reported PA five or more times per week. African-Americans consumed less FV (P < 0.001) and performed less PA (P < 0.001). Those consuming more FV and exercising more frequently had lower hypertension prevalence and tended to have better control rates. In a sample of southeastern residents, the control rate was suboptimal despite a relatively high rate of treatment. Low levels of FV consumption and PA were noted especially in African-American patients and may explain this rate.
    The American Journal of the Medical Sciences 11/2006; 332(4):211-5. · 1.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study is to characterize hospital and patient characteristics associated with administration of thrombolysis in acute ischemic stroke patients in the United States. This retrospective, observational, cohort study used data from the Nationwide Inpatient Sample, an administrative discharge database. A total of 366,194 hospitalizations admitted through the emergency department with a primary diagnosis of acute ischemic stroke were selected for analysis. The primary outcome considered in this study is whether the patient received thrombolytic therapy on hospital day 0 or 1. Thrombolysis was used in 1.12% (95% confidence interval [CI] 0.95% to 1.32%) of ischemic stroke hospitalizations. Most hospitals (69.5%; 95% CI 68.4% to 70.6%) treating ischemic stroke patients did not use thrombolysis during the study period. For the hospitals that used thrombolysis, the mean annual number of patients treated with thrombolysis per hospital was 3.06 (95% CI 2.68 to 3.44). In the binary logistic regression analysis, hospital characteristics associated with high use of thrombolysis were teaching hospital status and increasing number of stroke patients treated annually. Patient characteristics associated with higher use of thrombolysis were age younger than 55 years, male sex, and low comorbidity as measured by the modified Charlson Index; white race; and private self-pay health insurance. Use of thrombolysis for ischemic stroke in the United States from 1999 to 2004 was infrequent and showed significant differences, depending on hospital and patient demographic characteristics.
    Annals of emergency medicine 09/2007; 50(2):99-107. · 4.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Understanding how the timing of exposure to the US Stroke Belt (SB) influences stroke risk may illuminate mechanisms underlying the SB phenomenon and factors influencing population stroke rates. Stroke mortality rates for United States-born black and white people aged 30-80 years were calculated for 1980, 1990, and 2000 for strata defined by birth state, state of adult residence, race, sex, and birth year. Four SB exposure categories were defined: born in a SB state (North Carolina, South Carolina, Georgia, Tennessee, Arkansas, Mississippi, or Alabama) and lived in the SB at adulthood; non-SB born but SB adult residence; SB-born but adult residence outside the SB; and did not live in the SB at birth or in adulthood (reference group). We estimated age-, sex-, and race-adjusted odds ratios for stroke mortality associated with timing of SB exposure. Elevated stroke mortality was associated with both SB birth and, independently, SB adult residence, with the highest risk among those who lived in the SB at birth and adulthood. Compared to those living outside the SB at birth and adulthood, odds ratios for SB residence at birth and adulthood for black subjects were 1.55 (95% confidence interval 1.28, 1.88) in 1980, 1.47 (1.31, 1.65) in 1990, and 1.34 (1.22, 1.48) in 2000. Comparable odds ratios for white subjects were 1.45 (95% confidence interval 1.33, 1.58), 1.29 (1.21, 1.37), and 1.34 (1.25, 1.44). Patterns were similar for every race, sex, and age subgroup examined. Stroke Belt birth and adult residence appear to make independent contributions to stroke mortality risk.
    Neurology 12/2009; 73(22):1858-65. · 8.30 Impact Factor

Full-text (2 Sources)

Download
27 Downloads
Available from
Jun 10, 2014