How Geographic and Racial Factors Impact Stroke

REGARDS Participants by Location


Participants in the REGARDS study were recruited to match the geographical dispersion of stroke frequency in the first map. The blue dots represent the locations of African American participants and the red dots that of white participants.

Stroke is the best example of a disease that’s possible to prevent and very hard to treat, according to Dr. George Howard of UAB’s School of Public Health. And that’s just was he is working to do along with his colleague (and wife) Dr. Virginia Howard.

Alabama sits in the middle of the “stroke belt,” a Southeastern region where they happen significantly more frequently, and as studies show, where you live changes your risk by as much as three times. Another factor in stroke data is race. Among whites, only 11 percent of stroke deaths occur below age 65, but in African Americans stroke occurs at a younger age, resulting in 44 percent of stroke deaths occurring below age 65. It’s with these facts in mind that the Howards assembled a diverse team of scientists to design an observational study of risk factors for stroke aptly named the Reasons for Geographic and Racial Differences in Stroke (REGARDS).

People living in the Southeast are significantly more likely to die of a stroke than other parts of the country.

People living in the Southeast are significantly more likely to die of a stroke than other parts of the country.

Starting in 2003, their team conducted 45-minute telephone interviews about risk factors of stroke, and then sent health professionals into homes to perform medical tests, for 30,239 participants in the study. Since that time, each of the participants are contacted twice a year to assess their general health. So far the study has produced more than 300 papers on stroke and other diseases, and spawned 38 funded ancillary studies.

One focus for the study was on risk factor conditions like hypertension and diabetes. They found that African Americans are more aware of their blood pressure than whites, but that blood pressure medications don’t work as well in black people as in white. They also have shown that the impact of high blood pressure is three-times more “potent” to cause a stroke in blacks than whites.  All in all, the data shows that the development of hypertension needs to be better prevented and better controlled, so the researchers are now looking at how to help with that.

Outside of the exams, the study’s team sends participants birthday and holiday cards, as well as regular updates on the study and health tips that they have in turn shared with their friends and family. It’s these 30,239 people that the Howards emphasize are key to what they are doing over the course of their long-term efforts to decrease strokes. “The real heroes and heroines of this study are the participants,” George says.

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