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In stroke belt, teenage years key to future risk


For people living in the “stroke belt,” the teenage years may be a key period of vulnerability regarding future stroke risk, according to a study.

More people have strokes and die of strokes in the southeastern area known as the stroke belt than in the rest of the United States. So far, research has shown that only part of the difference can be explained by traditional risk factors such as diabetes and hypertension.

Previous studies have shown that people who were born in the stroke belt but no longer live there in adulthood continue to have a higher risk of stroke, along with people who were born outside the stroke belt but live there in adulthood.

For a study published April 24 on the website of Neurology, the medical journal of the American Academy of Neurology, researchers examined how long people lived in the stroke belt and their ages when they lived there to determine whether any age period was most critical in influencing future stroke risk.

Data came from the “Reasons for Geographic And Racial Differences in Stroke” study, a national random sample of the general population with more people selected from the stroke belt. The study involved 24,544 people with an average age of 65 who had never had a stroke at the start of the study, with 57% living in the stroke belt and 43% in the rest of the country. The study tracked each person’s moves from birth to present, with some people moving into or out of the stroke belt. The participants then were followed for an average of 5.8 years. During that time, 615 people had a first stroke.

After adjusting for stroke risk factors, only living in the stroke belt during the teenage years was associated with a higher risk of stroke. People who spent their teenage years in the stroke belt were 17% more likely to have a stroke in later years. Across all age periods, living in the stroke belt increased the risk about two-fold for African-Americans compared with Caucasians.

“Childhood emerged as the most important period of vulnerability to stroke belt residence as a predictor of future stroke,” the authors wrote. “Improvement in childhood health circumstances should be considered as part of long-term health improvement strategies in the stroke belt.”

“This study suggests that strategies to prevent stroke need to start early in life,” study author Virginia J. Howard, PhD, of the School of Public Health, University of Alabama at Birmingham, and a member of the American Academy of Neurology, said in a news release. “Many social and behavioral risk factors, such as smoking, are set in place during the teenage years, and teens are more exposed to external influences and gain the knowledge to challenge or reaffirm their childhood habits and lifestyle.”

The study was supported by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.

Read the study abstract:


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