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 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.

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    ABSTRACT: For decades, the Stroke Buckle region in the southeastern USA has had a high incidence of deaths from cerebrovascular disease relative to the rest of the country. We test here the possibility that temporary exposure to the Stroke Buckle can explain some of the excessive stroke mortality there. We examined all US death records between 1979 and 1988, noting whether individuals died inside or outside the 153-county Stroke Buckle in the coastal plains of North Carolina, South Carolina and Georgia. We also noted the decedents' county of residence, which was coded separately. Proportionate mortality ratios (PMRs) were used to assess the risk of dying of a stroke. Stroke Buckle residents who died in their home county were at an increased risk of dying of a stroke (PMR = 130.2; 95% confidence interval, CI = 128.9-131.6; p < 0.0001). Visitors to the Buckle were also at an increased risk of dying of a stroke (PMR = 111.9; 95% CI = 107.5-116.2; p < 0.0001), and Buckle residents who died while outside of the region were less likely to die of a stroke (PMR = 89.9; 95% CI = 86.2-93.6; p < 0.0001). These results show that even short-term exposure to the Stroke Buckle accounts for some of the elevation in stroke deaths there.
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