Geographic variation in cardiovascular disease mortality in US blacks and whites

Cardiovascular disease mortality rates have dropped significantly over the past several decades, but a shift has occurred over time in the geographic patterns of both coronary heart disease (CHD) and stroke mortality. This article describes these patterns and discusses how they vary by sex, race, age, and over time. Death certificate information for Health Service Areas (HSAs) in 1988-1992 was used to analyze the geographic patterns of CHD and stroke death rates by race, sex, and age. Changes in these patterns from 1979-1993 also were examined. In 1988-1992, considerable geographic variation in both CHD and stroke mortality was demonstrated for each sex and race group. Coronary heart disease rates were particularly high in the lower Mississippi valley and Oklahoma for all four groups, in the Ohio River valley and New York for whites, and to a lesser extent for blacks. Areas of high rates among whites in the Carolinas resemble stroke mortality patterns. There were greater differences by racial group than by gender, by the definition of heart disease. Over time, rates have declined for both CHD and stroke, but regional differences in the rates of change give the appearance of a southwesternly movement of high heart disease rate clusters and a breakup of the "Stroke Belt." Further research is needed to elucidate the cause of regional variation in CHD and stroke mortality. Similar geographic patterns of high rates of CHD and stroke in the southeastern United States may reflect common risk factors. This knowledge can be used to help develop appropriate interventions to target these high-rate areas in the Mississippi and Ohio River valleys.