The United States Stroke Belt

Why More Strokes Happen in Southern States

Getty Images

A number of states in the United States are associated with a higher rate of stroke than the rest of the country. This is such a recognized problem that a region of the United States has actually been dubbed 'the stroke belt' by the medical community and by public health experts.

Because stroke is one of the leading causes of death and disability, it is vital to understand what puts the southern population of the United States at higher risk of stroke, and to figure out how to prevent stroke among this at-risk population.

 If you are from the United States stroke belt, you should know the facts about how you can avoid becoming a victim of a stroke.

The Stroke Belt

Data from the Centers for Disease Control dating back at least 40 years indicate that individuals who are from the stroke belt are at least twice as likely to experience a stroke throughout their lifetimes as people of the same age who are not from the stroke belt. The states that have the highest rate of stroke in the United States are all geographically located in the southern region of the US. They are (in alphabetical order): Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. Interestingly, people who grew up in the stroke belt and moved to another state located outside of the stroke belt after childhood continue to be more likely to experience a stroke in adulthood than their age-matched peers.

Causes of Increased Stroke Among Individuals from the Stroke Belt 

There are several causes of this increased incidence of stroke that affects people who are from the United States stroke belt. In fact, the increased stroke incidence is such an important issue in American healthcare, that the data collected from tens of thousands of patients was used in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study.

This was a national, population-based, longitudinal study of white and black adults aged ≥45 years, who were enrolled in the study from 2003 to 2007. A number of stroke risk factors were carefully evaluated by teams of leading medical scientists to determine which of these elements were most responsible for the dramatically increased rate of stroke in the United States stroke belt. There were some interesting findings.

Dietary Patterns

Certain dietary patterns were found to have a substantial connection with the elevated risk of stroke and heart disease.  Most significantly, a specific dietary pattern which is identified as the Southern Dietary Pattern, was associated with an approximately 56 percent higher risk. This diet, according to the study authors, is characterized by added fats, fried food, eggs, organ and processed meats, and sugar-sweetened beverages. Diet has been shown to have an impact on multiple health issues, including diabetes, hypertension, fat levels and cholesterol levels, all of which are known to greatly impact stroke risk.

The Southern Dietary Pattern encompasses a few well-known staples that are particularly damaging to the body in ways that lead to stroke. Excessive fat in your diet can raise cholesterol and triglyceride levels, which are known to cause stroke. Fried foods and processed foods are typically abundant in a particular type of fat known as trans fat or partially hydrogenated fat. Trans fats are fats that are difficult for the body to properly metabolize. A high intake of trans fats is strongly linked with a high incidence of stroke. A diet that is heavy in fried foods, processed food, fats, and sugars is likely to lead to obesity and diabetes, both of which cause stroke.

Family History

Another important stroke risk factor is family history. Studies show that adults who have a family member who has had a stroke experience a 33 percent higher chance of having a stroke. There are a number of reasons for diseases to occur among family members. Genetics is the most obvious reason for a familial tendency to develop a particular disease. Certainly, genetics has an impact on stroke risk. For example, one recent study from the University of Vermont College of Medicine followed over 30,000 people to look for a genetic stroke link.

Over a period of five years, it was noted that people with blood type AB were more likely to have a stroke than people who had blood type O, blood type A, or blood type B. Blood type is a genetic trait. Incidentally, blood type AB is the least common of the 4 blood types. Sickle cell disease, one of the most well-known familial genetic blood disorders, is another strong cause of stroke. Several blood clotting disorders and heart conditions that run in families are also known to lead to stroke. There are, similarly, some rare familial disorders of the blood vessels in the brain that can lead to stroke.

But, despite all of this, researchers from Stanford University have found that it is lifestyle factors that are most responsible for the geographic variation in stroke risk in the United States, not genes. Certainly, genes play a role, but the scientists did a number of DNA sampling investigations and found that there is very little genetic variation among people who live in different regions throughout the United States. At the same time, there have been found to be other significant factors that vary from one region to another, including diet, smoking, alcohol use, education level, income, and use of health care resources, all of which play a strong role in leading up to a stroke.

Getting back to the likelihood of stroke among family members, it turns out that lifestyle habits such as dietary patterns, smoking, and getting proper healthcare are typically more similar among family members than among non-family members. This is, most certainty, a large part of the reason for familial association of stroke.

Can You Do Anything About Your Stroke Risk?

If you are from the stroke belt, if you live in the stroke belt or if you have a strong family history of stroke, that does not mean that you should expect to have a stroke in your lifetime. There are a number of things you can do to reduce your chances of having a stroke, even if you fall into a ‘high risk’ category. The following steps are very effective in reducing your chances of having a stroke, no matter where you are from.

Getting Tested for Stroke Risk Factors

There are a number of routine screening tests for stroke risk. In fact, your regular check-ups at the doctor’s office are often very effective screening check-ups for the most common causes of stroke. Does your doctor listen to your heart when you go in for a check-up? Then, you have had a stroke check up without even realizing it! You can find out more about how your regular visits to the doctor include screening tests for stroke here.

Stop Smoking

Many smokers do not want to hear this, but smoking is one of the most intense ways to damage your body and your brain. Smoking leads to serious damage of the blood vessels in your brain and in your heart. This raises your risk of stroke. However, surprisingly, the damage caused by smoking can reverse if you quit before the harm causes irreversible consequences such as stroke and cancer.

Weight Loss

Obesity is another stroke risk factor. There are a number of ways to lose weight. Weight loss is among the most challenging lifestyle issues a person may face. But, even a little progress towards your healthy weight can have a substantial impact on your health by reducing your chances of having a stroke.


That Southern Dietary Pattern is a hard habit to break. But, there are many people who have made small changes in dietary habits that make a big difference. For example, reducing your intake of fried foods can make a profound difference in your stroke risk by reducing your intake of trans fats.

Antioxidants are another important component of any diet. Find out more about the effects of antioxidants, which are health-promoting components of fresh fruits, vegetables and nuts. Substituting some processed foods with fresh fruit and vegetables can protect your body from damage.


Exercise has been proven to prevent stroke. Exercising does not mean that you need to completely change your life. You probably do not realize it, but there are a variety of exercises that you are already doing every week. The key is to increase those physical activities to reduce your chances of having a stroke.

Work Patterns

High stress working situations are associated with an increased stroke risk. Irregular shift schedules have also been linked to stroke. While work is something that few people have the power to control, there are a few steps you can take to ensure a more secure work environment. More importantly, if you are in a position to ensure a less toxic work environment for your colleagues or your subordinates, be aware that issues such as job security, long work hours, job stress and unpredictable work schedule heavily impact the health of your staff.  You can find out more about how long hours impact stroke risk and how shift hours impact stroke risk.

Positive Surroundings

Relaxation, meditation, spirituality, and good relationships all have been proven to reduce the risk of stroke. The vast majority of people are able to lessen stress and improve their quality of life with deliberate attention to stress reduction.

The United States stroke belt is a ‘real thing.’ But the increase in stroke among people from the stroke belt is not an unchangeable fact. You can take action to reduce your risk of stroke if you have health issues or lifestyle issues that put you in danger of having a stroke. Taking small steps towards stroke prevention can increase your life expectancy by a whopping 12.5 years.


Kennedy RE, Howard G, Go RC, et al. Association between family risk of stroke and myocardial infarction with prevalent risk factors and coexisting diseases. Stroke. 2012;43(4):974-9.

Rehkopf DH, Domingue BW, Cullen MR. The Geographic Distribution of Genetic Risk as Compared to Social Risk for Chronic Diseases in the United States. Biodemography Soc Biol. 2016;62(1):126-42.

Shikany JM, Safford MM, Newby PK, Durant RW, Brown TM, Judd SE. Southern Dietary Pattern is Associated With Hazard of Acute Coronary Heart Disease in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Circulation. 2015;132(9):804-14.

Verduzco LA, Nathan DG. Sickle cell disease and stroke. Blood. 2009;114(25):5117-25.

Zakai NA, Judd SE, Alexander K, et al. ABO blood type and stroke risk: the Reasons for Geographic And Racial Differences in Stroke Study. J Thromb Haemost. 2014;12(4):564-70.

Continue Reading