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"Stroke Belt" Parallel in Children Raises Questions Regarding Causes: Presented at ISC

By Paula Moyer

SAN DIEGO, CA -- February 9, 2004 -- The geographic distribution of pediatric stroke in the United States mirrors that of adults, with significantly more stroke-related mortality among children occurring in the southeastern region of the country, according to findings presented here February 6^th at the American Stroke Association's 29^th International Stroke Conference.

"If stroke in adults could be solely attributed to risk factors such as atherosclerosis and hypertension, we would not see this geographic concentration in children," said principal investigator Heather J. Fullerton, MD, clinical instructor of neurology, University of California at San Francisco. "These modifiable risk factors are not the causes of pediatric stroke."

Dr. Fullerton and co-investigators analyzed death certificate data for both ischemic and hemorrhagic stroke in 2 cohorts: children younger than 20 years and adults 25 years or older. The researchers targeted the years 1979 through 1998, for which they compared stroke mortality rates in 11 so-called "stroke belt" states and other states that were used as controls. The "stroke belt" states consisted of Alabama, Arkansas, Georgia, Indiana, Louisiana, Mississippi, North Carolina, South Carolina, and Virginia.

Mortality rates were calculated as deaths per 100,000 person-years and adjusted to the United States population as it existed in the year 2000.

Results show that children in the targeted states were 21% more likely to die from stroke compared to children in other states, and that they had an 18% increased risk for death from hemorrhagic stroke and a 27% greater likelihood of dying from ischemic stroke.

The geographic disparity in children was similar to that in adults. Gender played no role, nor did age within pediatric age groups.

African-American children were no more likely overall to die of stroke, with a relative risk of 1.12 (P = .07). However, such children in "stroke belt" states were 49% more likely to die of ischemic stroke compared to African-American children in other states (P < .001).

"The fact that we found this geographic concentration in children means that we need to identify other causes of stroke," Dr. Fullerton said. "Such causes could range from lack of access to health care, genetics, and environmental risks that have yet to be identified. The next step is to explore risk factors for pediatric stroke and then see if these findings help us make more sense of this geographic concentration."


[Study title: The Pediatric Stroke Belt: Geographic Variation in Stroke Mortality in U.S. Children. Abstract P296]

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