Geography of Stroke Mortality: Hotspotting Areas for Targeted Interventions (P5.009)

OBJECTIVE: We used spatial modeling to identify well-defined areas of the US where stroke related death rates were disproportionately high (hot spots) or low (cold spots). BACKGROUND: Geographic disparities in stroke mortality are well described. To reduce geographic disparities, identification of contiguous areas of the US that have a high burden of cerebrovascular disease is critical. DESIGN/METHODS: US county death data from the 2010 Multiple Cause of Death data files (National Center for Health Statistics) were combined with 2010 Area Resource File demographic data. Stroke deaths were identified using previously described ICD-10 (I60-69). Local tests of spatial autocorrelation (LISA statistic) were conducted in ArcGIS to identify locations where disproportionately high or low stroke death rates were clustered. RESULTS: Across 3133 counties in the United States the median age-adjusted stroke mortality rate for adults (18+) was 59.9 deaths per 100,000 people (IQR 46.8-76.6). There were 284 counties identified as hot spots (P<0.01) with a median stroke mortality rate of 103.0 (IQR 93.1-123.2). There were 152 counties identified as cool spots (P<0.01) with a median stroke mortality rate of 26.1 (IQR 0-37.0). Hot spots were clustered in the Southeastern US, but also extended west to Texas and Oklahoma. Additional hot spots were noted in North Dakota and Montana. CONCLUSIONS: Geographic analysis can be used to identify clusters of high stroke mortality rates. These techniques may help identify geographic areas for targeted interventions to improve population health. Further study should assess the stability of these findings over time and determine reasons for the clustering. Study Supported by: R01 HS018362-01A1 AHRQ Disclosure: Dr. Wolff has nothing to disclose. Dr. Mullen has nothing to disclose. Dr. Mullen has nothing to disclose. Dr. Branas has nothing to disclose. Dr. Carr has received research support from the Agency for Healthcare Research & Quality, the Center for Disease Control & Prevention, and the National Institutes of Health.