Dramatic effects of nativity on strokebelt mortality in blacks

The Southeastern Strokebelt has been recognized as an area of excess cerebrovascular disease mortality for several decades. This study assesses the effects of nativity (birthplace) and stroke mortality in South Carolina (SC). Proportional mortality ratios (PMR) were calculated for SC deaths considering individuals born in SC, the Southeastern United States, and individuals born outside the Southeast. The PMRs were adjusted for age and stratified by race for deaths occurring from 1980 to 1993. While these results suggest lower stroke mortality risks for both race groups born outside the Southeast, the effects of nativity on stroke mortality appear to be much greater in blacks. This assessment is limited due to the inability to measure length of residency. Nevertheless, these findings indicate that the factors associated with the excess stroke mortality are indigenous rather than acquired.