Share this article on:

Small-Area Racial Disparity in Stroke Mortality: An Application of Bayesian Spatial Hierarchical Modeling

Tassone, Eric C.a; Waller, Lance A.b; Casper, Michele L.c

doi: 10.1097/EDE.0b013e3181935aee
Spacial Epidemiology: Original Article

Background: In the United States, excess burden of stroke mortality has persisted among African Americans compared with whites despite declines in stroke mortality for both groups. New insights may be gleaned by examining local, small-area patterns in racial disparities in stroke.

Methods: The study population includes all non-Hispanic African Americans and non-Hispanic whites aged 35 to 64 in the southeastern United States during 1999 to 2002. We assessed county-level numbers of stroke deaths and population estimates in a Bayesian spatial hierarchical modeling framework allowing for inclusion of potential covariates (poverty and rurality), and generating county-specific model-based estimates of both absolute and relative racial disparity. The resulting estimates of race-specific stroke death rates, relative racial disparity, and absolute racial disparity were expressed in maps.

Results: After adjustment for age, poverty, and rurality, county-level estimates of relative racial disparity ranged from 2.3 to 3.3 and estimates of absolute racial disparity ranged from 19 to 45 excess deaths per 100,000. For both racial groups, stroke death rates were higher in rural areas and with increasing poverty. High relative racial disparity was concentrated primarily in the eastern portion of the region and large absolute racial disparity was concentrated primarily in the western portion.

Conclusions: The results highlight the pervasiveness and magnitude of substantial local racial disparities in stroke mortality in the southeast.

SUPPLEMENTAL DIGITAL CONTENT AVAILABLE ONLINE IN THE TEXT.

From aEmory University; and bDivision for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, cCenters for Disease Control and Prevention, Atlanta, GA.

Submitted 2 February, 2006; accepted 3 September, 2008; posted 12 January 2009.

Supported by Environmental Protection Agency “Science to Achieve Results” (STAR) Fellowship 91589901-0, an Association of Schools of Public Health and Centers for Disease Control and Prevention Public Health Fellowship S22/22-CCD03-015, and National Institute of Environmental Health Sciences Grant R01-ES07750.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Trade names are provided for informational purposes only and do not constitute an endorsement by the Centers for Disease Control and Prevention or the US Department of Health and Human Services.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Editors' Note:A commentary on this article appears on page 242.

Correspondence: Eric C. Tassone, P.O. Box 192051, San Francisco, CA 94119. E-mail: erictassone@gmail.com.

Small-area racial disparity in stroke mortality: An application of Bayesian spatial hierarchical modeling: Erratum

The authors' affiliations should read as follows:

Tassone EC,a,b Waller LA,a Casper MLb

aEmory University; and bDivision for Heart Disease and Stroke Prevention, National Center for Chronic

Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

© 2009 Lippincott Williams & Wilkins, Inc.