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Georgia and nine other Southern states have the highest stroke rates in the country, according to a new study that reinforces the region's reputation as the nation's "stroke belt."
Higher rates of high blood pressure, diabetes, smoking and obesity --- especially among the area's large population of African-Americans --- contribute to the region's heavy burden of stroke, researchers said. Higher poverty rates and inadequate access to health care also play a role, they said.
Environmental issues, such as air pollution and water quality, could be additional factors, others have said.
"We've known about the stroke belt for years, but nothing has panned out as a single factor that can explain it," said Dr. George Mensah, chief of the cardiovascular health program at the Centers for Disease Control and Prevention.
The new study, released Thursday by the Atlanta-based CDC, looked at hospitalization rates for stroke in 2000 among people age 65 or older on Medicare, the government health plan for seniors.
Mississippi topped the list, with 21.9 stroke patients per 1,000 people on Medicare. Alabama was next, followed by Louisiana, West Virginia and Arkansas.
Rounding out the top 10 were Kentucky, Tennessee, Georgia, South Carolina and North Carolina.
Georgia's rate was 18.6 stroke patients per 1,000 Medicare enrollees. Nationally, the rate was 16.3 patients per 1,000 people on Medicare.
New Mexico had the lowest rate, with 11.8 stroke patients per 1,000 people on Medicare. Connecticut, Maine, Utah and Vermont tied for the next lowest.
Strokes, sometimes called "brain attacks," occur when blood flow to the brain is interrupted by a clogged or ruptured blood vessel. Strokes can be fatal or cause temporary or permanent paralysis, muscle weakness, blindness, memory loss and difficulty in speaking and eating.
About 168,000 people died from stroke in 2000, making it the country's third-leading cause of death.
The CDC study found that half of patients with stroke were sent home after being released from the hospital. One-fifth went to nursing homes and another fifth went to other facilities, such as assisted living centers. Nearly 9 percent died in the hospital.
Going home is best because it indicates patients aren't as disabled, Mensah said. Home health care also is better and more cost effective for stroke recovery than care in nursing homes, other research has found.
Men were hospitalized for stroke 21 percent more than women and blacks 30 percent more than whites, according to the CDC study.
Better awareness of stroke symptoms, proper treatment of related conditions and improved lifestyles could help the South curb its stroke problem, doctors said.
Many people don't realize that sudden headaches, blurred vision, slurred speech and numb limbs --- especially on only one side of the body --- often indicate stroke, Mensah said. Some treatments, such as "clot busting" drugs, are effective only within the first three hours.
To control stroke risk factors, patients need to see physicians regularly for basic screening tests, said Dr. Mark Alberts, a neurologist at Northwestern University in Chicago. He is director of the Stroke Belt Consortium, which educates patients and doctors about stroke.
Drugs can lower high blood pressure and help control diabetes, reducing the risk of stroke, Alberts said.
"If you don't get screened for high blood pressure and diabetes, you don't know you have those conditions, so they're hard to treat," he said.
Dr. Joseph Miller, an Emory University cardiologist, said eating a low-fat diet, exercising and not smoking are keys to lowering stroke rates.
But he noted that childhood obesity is on the rise.
"Here we are cutting back on physical education in schools and adding vending machines," he said. "The problem could be feeding itself."
Copyright 2003 The Atlanta Journal-Constitution
