Abstract
INTRODUCTION: Stroke, a leading cause of illness, death, and long-term disability in the US, presents with significant disparities across the country, most notably in southeastern states comprising the "Stroke Belt." This study intended to identify differences between Stroke Belt states (SBS) and non-Stroke Belt states (NSBS) in terms of prevalence of stroke, sociodemographic and behavioral risk factors, and health-related quality of life (HRQOL). METHODS: We analyzed data from the 2019 Behavioral Risk Factor Surveillance System to compare demographic characteristics, risk factors, physical activity adherence, functional independence, and HRQOL among stroke survivors in SBS and NSBS. RESULTS: Of 18,745 stroke survivors, 4,272 were from SBS and 14,473 were from NSBS. Stroke was more prevalent in SBS (odds ratio [OR] = 1.39; 95% CI, 1.35-1.44; P < .001), with significant differences by age, sex, and race and ethnicity, except for Hispanic ethnicity. Selected stroke risk factors were more common in every category in SBS. Stroke survivors in SBS were less likely to meet physical activity guidelines for aerobic (OR = 0.77; 95% CI, 0.69-0.86; P < .001) and aerobic and strengthening combined (OR = 0.77; 95% CI, 0.70-0.86; P < .001) activities. Stroke survivors in SBS were more likely to not meet either physical activity guideline (OR = 1.31; 95% CI, 1.22-1.41; P < .001). CONCLUSIONS: Living in SBS significantly increased the odds of stroke occurrence. Stroke survivors from SBS reported lower HRQOL and insufficient physical activity as well as lower functional independence. Specific strategies are needed for residents of SBS, with a focus on policies and primary and secondary prevention practices across healthcare professions.