Study finds people raised in the Stroke Belt are at increased risk

Children and teens living in the Stroke Belt states are at about twice as much risk of stroke later on in life according to new findings from the REGARDS study.

Stroke is the fourth leading cause of death in the United States. Experts at the University of Alabama at Birmingham (UAB) have found that living in Stroke Belt states — Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina and Tennessee — early in life, increases the risk of stroke, according to a new study published in the April 24, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology.

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The study’s aim is to determine reasons for higher stroke death rates in the “Stroke Belt” stretching across Alabama, Arkansas, Louisiana, Mississippi, North Carolina, South Carolina, Georgia and Tennessee. (UAB Magazine)

“Living in the Stroke Belt at any age tended to increase stroke risk,” explained Virginia Howard, Ph.D., UAB professor of epidemiology and lead study author. “But living in the stroke belt as a child or teenager appears to impart about twice as much stroke risk as living there as an adult.”  

Data from 24,544 people in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study age 45 and older who had not previously had a first stroke, and who lived in the Stroke Belt at different ages were used to see if living there during particular ages put people at higher or lower risk of having a stroke as an adult.

According to study results, if a person lived in the stroke belt for their first 12 years, or between ages 13-18, the risk of having a stroke was 22 percent higher. In comparison, a current resident of the stroke belt – which includes a mix of participants who lived in the Stroke Belt as a child and those who did not – was at only a 13 percent higher risk of stroke. African Americans saw a bigger difference; for the age period of 13-18, the increase in stroke risk was about 33 percent, compared to 15 percent for whites.

“We speculate this is because childhood and the teenage years are when many life-long habits and decisions are made that put you at higher risk of developing risk factors such as hypertension or diabetes when you are middle-aged,” Howard said. “It is when your dietary patterns are first set and when you are deciding whether to be physically active, and these factors subsequently increase the risk of having a stroke as an older adult.” 

“Living in the Stroke Belt at any age tended to increase stroke risk. But living in the Stroke Belt as a child or teenager appears to impart about twice as much stroke risk as living there as an adult.”  

Additionally, Howard said that hardening of the arteries has been shown to begin in early childhood and progresses over decades to lead to acute events such as stroke and heart attack.

“This implies that if we are going to prevent strokes in adults, waiting until underlying problems such as hypertension and diabetes develop may be too late, so we need to start in childhood,” Howard noted, adding that there is a need for further work to better understand the mechanisms related to living in the Stroke Belt during younger ages.

For now, Howard said, the message is clear; it is critically important to focus on childhood and adolescent interventions and activities to prevent or manage the risk factors that could lead to stroke many years later. 

This study was supported by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.

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