Stroke in a biracial population: the excess burden of stroke among blacks

Stroke. 2004 Feb;35(2):426-31. doi: 10.1161/01.STR.0000110982.74967.39.


Background and purpose: Excess mortality resulting from stroke is an important reason why blacks have higher age-adjusted mortality rates than whites. This observation has 2 possible explanations: Strokes occur more commonly among blacks or blacks have higher mortality rates after stroke. Our population-based epidemiological study is set in the Greater Cincinnati/Northern Kentucky region of 1.31 million people, which is representative of the US white and black populations with regard to many demographic and socioeconomic characteristics.

Methods: Hospitalized cases were ascertained by International Classification of Diseases (ninth revision) discharge codes, prospective screening of emergency department admission logs, and review of coroner's cases. A sampling scheme was used to ascertain cases in the out-of-hospital setting. All potential cases underwent detailed chart abstraction by study nurses, followed by physician review. Race-specific incidence and case fatality rates were calculated.

Results: We identified 3136 strokes during the study period (January 1, 1993, to June 30, 1994). Stroke incidence rates were higher for blacks at every age, with the greatest risk (2- to 5-fold) seen in young and middle-aged blacks (<65 years of age). Case fatality rates did not differ significantly in blacks compared with whites. Applying the resulting age- and race-specific rates to the US population in 2002, we estimate that 705,000 to 740,000 strokes have occurred in the United States, with a minimum of 616,000 cerebral infarctions, 67,000 intracerebral hemorrhages, and 22,000 subarachnoid hemorrhages.

Conclusions: Excess stroke-related mortality in blacks is due to higher stroke incidence rates, particularly in the young and middle-aged. This excess burden of stroke incidence among blacks represents one of the most serious public health problems facing the United States.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • African Continental Ancestry Group / statistics & numerical data*
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • European Continental Ancestry Group / statistics & numerical data*
  • Female
  • Humans
  • Incidence
  • Inpatients / statistics & numerical data
  • Kentucky / epidemiology
  • Male
  • Middle Aged
  • Mortality / trends
  • Odds Ratio
  • Ohio / epidemiology
  • Outpatients / statistics & numerical data
  • Risk Factors
  • Sex Distribution
  • Stroke / epidemiology*
  • Stroke / mortality
  • United States / epidemiology