Matthew Edwardson, MD

Hunt BR, Deot D, and Whitman S. Stroke Mortality Rates Vary in Local Communities in a Metropolitan Area:Racial and Spatial Disparities and Correlates. Stroke. 2014

Many factors influence the stroke mortality rate. Thankfully, some of these factors are reversible, yet it remains challenging to identify the best approach to improve public health. One method is to identify vulnerable populations and target them for public health initiatives. This article by Hunt and colleagues identifies such populations in the city of Chicago. Not surprisingly, the highest mortality rates were on the South and West sides of Chicago in mostly poor and black communities.

The authors reviewed death certificates over the span of 3 years in Chicago, documenting cause of death, race, and neighborhood of residence. They discovered that the overall stroke mortality rate was higher in Chicago than the national average (44.9 vs. 42.2 per 100,000 respectively, P < 0.001); however, the rates for each individual race were lower than the national average for each respective race with the exception of Puerto Ricans. This suggests the high stroke mortality rate overall in Chicago is driven by the large black population, who experienced higher rates than the other races (57 per 100,000).  Low socioeconomic status correlated with increased stroke rates in black neighborhoods, but not in neighborhoods predominated by other races.  Somewhat surprisingly, the stroke mortality rate among Mexicans was much lower than the rate for all other races including whites.      

I lived in Chicago during my medical school training and can foresee how the disparities discovered by Hunt and colleagues may lead to improved public health in the city. According to the authors, residents in the neighborhood with the highest stroke mortality were 5 times more likely to die of stroke than those in the neighborhood with the lowest mortality. Improving access to care in the communities with the highest stroke mortality rates is one way to address this disparity. 

During medical school I had the opportunity to do a rotation at the Lawndale Christian Health Center. The residents of the North Lawndale community served by this clinic were predominantly poor and black. It was amazing to witness the impact that affordable health care had on this community. Nonetheless, North Lawndale had the 5th highest stroke mortality rate in Chicago according to the authors.  While adding additional clinics to this neighborhood might have had more impact, there are clearly many factors that contribute to stroke mortality, not just access to care. Now that the authors have identified the most vulnerable populations and neighborhoods, more work can be done to tease apart the root cause of increased stroke mortality in Chicago and ultimately improve public health.