Stroke mortality in the U.S. black population is generally recognized to be approximately 1.5 times that observed in the U.S. white population. There is a growing awareness that observed ethnic differences in mortality may be largely due to differences in socio-economic status (SES). Stroke mortality has been related to income, educational level, and other measures of SES. Because of the clear SES differences between U.S. racial groups, this may be acting as a confounder in the assessment of racial differences in stroke. In addition, the black excess stroke mortality is not consistent across all components of the population. For example, there is a four-fold black-to-white excess in stroke mortality at age 45, but by age 85 the black-to-white risk is approximately the same. Not only is identification of subgroups of blacks at extraordinary risk of great interest, but also it is reasonable to assume that the impact of SES may differ as a function of demographic, and other social support factors. This project will use data from the National Longitudinal Mortality Study (NLMS) to evaluate the proportion of the excess stroke mortality among the U.S. black population that is attributable to racial differences in SES. Secondary aims are to assess the impact of other demographic, geographic, and social support factors on racial differences in stroke mortality. These factors will be considered as a potential effect modifiers in the assessment of the role of SES on racial differences in stroke mortality. In addition, secondary analyses will be conducted to examine the impact of other factors in the data set (i.e., geographic variations in mortality rates) and the impact of SES on other diseases (i.e., ischemic heart disease).
