When it comes to stroke, black Americans face a risk three to four times higher than whites do. Now, new research suggests that African Americans who live in the "Stroke Belt" a large swath of the South are especially likely to suffer from stroke.

Essentially, the Stroke Belt provides "an extra kick against African-Americans. The impact is even a little bit bigger" for them, said George Howard, lead author of a new study and chair of the Department of Biostatistics at the University of Alabama at Birmingham.

The average ratio of stroke deaths among blacks compared to whites is 6 to 21 percent higher in Southern states than in other states, according to the study.

Researchers have long known about the so-called Stroke Belt phenomenon, which they first discovered in the mid-1960s. According to Howard, people in all Southeastern states, excluding Florida, are 24 to 50 percent more likely to die of stroke than people in other parts of the country are.

Howard and colleagues examined 1997-2000 health statistics from 26 states with significant black populations and looked for discrepancies in stroke mortality rates among those ages 45 and older. They report their findings in the September issue of the Annals of Epidemiology.

The researchers found higher mortality among blacks compared to whites across the South, even in Virginia and Florida, states that are not part of the Stroke Belt. It is as if blacks "sort of get penalized once for being African-American, once for being Southern and once for being black and Southern," Howard said.

Why? Howard isn't sure, but he thinks high blood pressure and diabetes play a role.

For now, "we need to collect better information on lifestyle and dietary factors that will allow us to evaluate whether it's really lifestyle that's driving the increased risk here," said Tobias Kurth, M.D., an associate epidemiologist at Brigham and Women's Hospital in Boston who's familiar with the study findings.

Ultimately, Kurth said, more details can lead to preventive strategies that might reduce the stroke gap.

Howard G, et al. Regional differences in African Americans' high risk for stroke: the remarkable burden of stroke for Southern African Americans. Ann Epidemiol 17(9), 2007.

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