Secular trends in stroke mortality in African Americans: The role of urbanization, diabetes and obesity

The decline in stroke mortality rates in African Americans has slowed to that seen in the 1960s; rates remain higher than in European Americans. Rates are higher in the southeastern US and in nonmetropolitan areas. Adverse trends and patterns in diabetes, obesity, and heart disease prevalence are possible explanations. Unless new, effective prevention programs are introduced in African American communities, stroke mortality rates will decline slowly if at all. The best chance to increase the rate of decline in stroke mortality rates in African Americans may be to redouble efforts to achieve the goals for the year 2000. Community and patient education on improving diet, increasing exercise, further improving detection and control of hypertension, using aspirin in stroke prevention and active control of stroke risk factors in diabetics must be stressed.