March 7, 2007 — Stroke Buckle

Within the Southern states with the highest rates of stroke, the heaviest economic toll may be in the coastal plains of North Carolina and South Carolina
By Betty Joyce Nash

The Southeast is known for its hospitality and warm climate, but it has a more dubious distinction too. The region has historically been the nation's "stroke belt." In the Fifth District, North Carolina and South Carolina have the second- and sixth-highest number of deaths, respectively, resulting from the brain being deprived of oxygen, according to 2003 data published by the American Heart Association in 2007.

Within this region, the coastal plain counties in the Carolinas and in Georgia are called the "stroke buckle" — their stroke death rates are twice as high as the national average. Some have pointed to differences in lifestyle, diet, and incidence of high blood pressure. These factors often are correlated with lower levels of income, and large parts of the South still lag the nation in that category. But poor health in the region may also be contributing to poverty.

Stroke and cardiovascular diseases take their toll on society. Aside from billions of dollars in health care costs, the economic consequences can be pernicious.

The labor force suffers, for example. Chronic noncommunicable diseases like stroke cut productivity through absenteeism, disability, and early retirement, according to Dele Abegunde, a researcher at the World Health Organization. "In contrast, good health improves levels of human capital which may in turn positively affect individual productivity and ultimately affect economic growth rates," Abegunde wrote in a paper published in 2006.

Productivity and health are two sides of the same coin. "Workers can have all the skills but if they're relatively unhealthy and unable to be at work, then those skills aren't going to help," says Donald Schunk, a research economist at Coastal Carolina University's Center for Economic and Community Development. "Health in general is an important piece of economic infrastructure that tends to get overlooked in that conversation about how we can grow our economy."

There's a deeper problem. Stroke and other debilitating conditions deprive families and communities of income and savings, choking future economic possibilities and potentially contributing to a cycle of poverty.

Take a mother with risk factors for stroke — smoking, poor diet, lack of access to health care, and lack of physical activity. Her offspring may have to become her caregivers if she suffers a debilitating stroke, Schunk says. "The children ideally would be going to school and investing in their own knowledge and human capital, but they may have to work. Health problems for parents translate into reduced education and labor skills for the next generation."

The people most affected by stroke are often those who need jobs and education the most. Rates of premature deaths from heart disease and strokes, for example, are higher for African Americans, a group that on average is poorer than the nation as a whole.

Lee County, S.C., is a rural county in the stroke buckle. There, per-capita income ranked 42nd out of the state's 46 counties and was 59 percent of the national average in 2004, according to the Bureau of Economic Analysis. Only 6.5 percent of the county's population over 25 years old had a bachelor's degree, 35 percent were high school graduates, and 63 percent were black, according to the 2000 Census.

It isn't known whether the depressed economic conditions in the stroke buckle are partly caused by the higher stroke mortality rate, or vice versa. But what about the effect of retirees moving to the Southeast? The risk of stroke also increases as people get older.

"While the net effect of migration on geographic variation in stroke mortality has not been determined, patterns of elderly interstate migration may strongly influence the stroke mortality rates in the principal retirement destination states," noted a 1993 paper in Neurology.

But the effect may not be what one might expect. For example, since World War II, Florida has had a steady influx of healthy elderly whites from Northern states with low stroke mortality rates. This may have actually helped keep the state's stroke mortality rate down, making it one of the few places in the Sunbelt that isn't in the stroke belt.

In an economic development effort with multiple purposes, three of South Carolina's public universities and three private health corporations comprise Health Sciences South Carolina, formed in 2004. The group wants to create a "health cluster" in research and education that will not only generate jobs but also yield useful information to improve peoples' health and productivity.

Health Sciences South Carolina received a $21 million, three-year grant from the Duke Endowment in August 2006. The grant will add to investments from the group's partners and matching state funds totaling $160 million over the next 10 years.

Related Links:

Lanska, Douglas J. "Geographic Distribution of Stroke Mortality in the United States: 1939-1941 to 1979-1981." Neurology, September 1993, vol. 43, no. 9, pp. 1839-1851.

Rosamond, Wayne, et al. "Heart Disease and Stroke Statistics — 2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee." Circulation, February 6, 2007, vol. 115, no. 5, pp. 69-172.