Posted on October 9, 2002 at 10:30 a.m.
BIRMINGHAM, AL — The University of Alabama at Birmingham (UAB) has received a five-year, $28 million grant from the National Institute of Neurological Disorders and Stroke to investigate why the rate of stroke death is significantly higher in the Southeastern region of the United States and why blacks are more likely to die from stroke than whites. The grant is the largest ever awarded to the university for a single five-year research study.
The study, called Reasons for Geographic And Racial Differences in Stroke (REGARDS), aims to determine why the “stroke belt” — the eight-state region comprising North Carolina, South Carolina, Georgia, Tennessee, Alabama, Mississippi, Arkansas and Louisiana — has a stroke death rate one-and-a-half times the national average. Researchers will also study the “stroke buckle” — a defined area along the costal plains of North Carolina, South Carolina and Georgia — which has a stroke death rate twice the national average.
“Increased rates account for approximately 9,000 more stroke events each year in this region,” said George Howard, Dr.P.H., professor and chair of the department of biostatistics in the School of Public Health at UAB and principal investigator of the study. “The estimated economic impact of these ‘extra’ deaths is staggering — nearly $1 billion a year.”
UAB President Dr. Carol Z. Garrison says the NIH grant positions UAB as a national leader in stroke research. “We are pleased to lead this groundbreaking study on a major public health foe. While this research will be performed on a national stage, it is gratifying to know that our findings will aid the residents of our state and region who are disproportionately affected by stroke.”
Proposed theories attribute the region’s higher stroke mortality to various geographic differences: fewer healthy choices in diet or exercise, a high prevalence of risk factors such as high blood pressure and diabetes; the drinking water; and lifestyle choices. “There is evidence to support all these theories to varying degrees,” said Howard. “And there is evidence to dispute them. We ought to know what’s causing this, but we don’t.”
“Nationally, African-Americans have about a 40 percent greater risk of dying from stroke than whites,” said Howard. “More disturbing, research indicates younger African-Americans, ages 35 to 54, bear most of the excess burden. They are four times more likely to die of stroke than any other race or age group. We need to know why.”
The study will provide the first direct assessment of the number of strokes and stroke deaths that occur each year in the United States. “It is estimated that more than 750,000 Americans suffer a stroke each year,” said Virginia Howard, M.S.P.H., research assistant professor of epidemiology at UAB. “However, this estimate is largely based on data from only selected regions of the country, and there is little direct data for blacks.”
LeaVonne Pulley, Ph.D., associate professor of health behavior at UAB, will direct recruitment efforts to enroll 30,000 healthy men and women age 55 and older from across the nation to participate in the study. Half of the participants will be recruited from Southern states and half will be African-American. “The study will include the largest number of African-Americans ever enlisted in a stroke study,” said Pulley.
Participants will be identified through a random selection process, then contacted by telephone and mail. Following an initial telephone interview, eligible participants will be given an in-home physical by a healthcare professional. “This is a novel approach,” said George Howard. “Being a single-site study and not having the resources to send nurses cross-country, we have contracted with a national health assessment organization to perform physicals in participants’ homes or at their work and to provide us with the information.”
Researchers will call participants every six months to conduct a brief telephone interview. “If a participant dies or experiences a serious illness, we will request a copy of his or her medical record,” said Dr. Camilo Gomez, professor of neurology at UAB. “We will review the information to assess whether the death or illness was stroke-related. This will ensure consistent and accurate reporting of stoke occurrences and deaths.”
NINDS awarded the grant following a successful one-year pilot study by the research team. “This is an ambitious and innovative project involving a diverse population,” said Dr. Audrey Penn, acting director of NINDS. “Results will give us much needed information about what is going on in the Stroke Belt with regard to stroke occurrences, deaths and associated risk factors. Findings will most certainly give us a better insight into a major public health issue.”
“Funding a study of this magnitude is a bold move on the institute’s part,” said George Howard. “This study takes the commitment on the NIH’s part to a new level. NINDS is stepping up to the plate, and we are thrilled with its support of this study and the quest for answers to so many questions regarding stroke.”
Other UAB investigators include Katharine Kirk, Ph.D., professor of biostatistics, who will lead the statistical analysis team, and Rodney Go, Ph.D., professor of epidemiology, who will lead the genetic analysis team.
Dr. Mary Cushman, associate professor of medicine and pathology with the University of Vermont College of Medicine in Burlington, will direct the central laboratory for the project.
NOTE: The University of Alabama at Birmingham is a separate, independent campus from the University of Alabama, which is located in Tuscaloosa. Please use University of Alabama at Birmingham on first reference and UAB on second reference.
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