The Great Migration And Stroke Risks: Did Leaving The Stroke Belt Protect African-American Migrants From Stroke? Open Access

Mathieson, Emery (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/bk128b33w?locale=en
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Abstract

The Great Migration and Stroke Risks: Did Leaving the Stroke Belt Protect African-American Migrants From Stroke?

Emery Mathieson

Objective

The Great Migration, the massive exodus of African-Americans out of the American South to urban centers in the north and west that following the American Civil War until the 1970s, offers an opportunity to test whether leaving the South protected African-Americans from stroke compared with those who stayed behind. This study aims to contribute to knowledge about associations between location and stroke health amongst African-Americans.

Methods

The association of migration out of the Stroke Belt (SB) region with history of stroke was studied in a sample of 6,983 African-Americans born in the SB region. Data were from the REGARDS Stroke study. Stroke history was judged by self-report, past stroke symptoms, or both. Created location variables measured exposure to SB: stayed in SB or left age ≤30, portion of life in SB, and age one left the SB. Descriptive statistics and T-tests measured changed across both location and stroke outcome strata. Regression models were used to evaluate associations between one of three location variables (reported above) and history of stroke. Models were adjusted for motivations for migration seen in the Great Migration. Controlling for these factors evaluated if migration itself or rather the motivators and outcomes of migration have an association with history of stroke.

Results

For each bivariate model, time spent in the SB had a statistically significant association with stroke history [Set A OR 1.18 (1.06,1.32), Set B OR 1.26 (1.08,1.48), Set C OR (Age 18-30 level) 0.75 (0.65,0.86)]. Adjusting for variables mirroring the economic and educational motivators of migration seen in the Great Migration, each location variable representing exposure to the SB region grew statistically insignificant.

Conclusions

The association between migration out of the SB and changes in indications of stroke come not from the migration itself; rather the opportunities afforded only to an African-American living outside the SB modify stroke risk. It is predicted that racism and discrimination in the SB region limit the opportunities that African-Americans can achieve, forcing many to migrate elsewhere to be afforded such opportunities and to experience the health benefits associated.

Table of Contents

Introduction............................................................................................................. 1

Background................................................................................................................... 1

Objective And Research Question............................................................................... 2

Significance.................................................................................................................... 3

Literature Review..................................................................................................... 4

Clinical Information on Strokes................................................................................ 4

Pathology and Pathogenesis of Strokes.................................................................................. 4

Health Impacts of Stroke..................................................................................................... 6

Treatments for Strokes........................................................................................................ 7

Conceptual Links to Stroke Risk............................................................................... 11

Bio-Demographic Factors.................................................................................................. 12

Socio-Economic Factors.................................................................................................... 14

Behavioral Factors........................................................................................................... 16

Health Factors................................................................................................................. 18

Understanding Links Between Location and Stroke Risk..................................... 18

Stroke Belt...................................................................................................................... 18

Temperature and Stroke Risk.............................................................................................. 19

Environment and Stroke Risk.............................................................................................. 22

Pollution and Stroke Risk.................................................................................................. 23

Migration and the Impact on Health....................................................................... 24

Dynamics of Migration...................................................................................................... 24

The Great Migration......................................................................................................... 26

Conceptual Framework............................................................................................. 30

Study Population Defined.................................................................................................. 30

Racism and Dichotomy of Opportunity in the Stroke Belt......................................................... 31

Big Picture...................................................................................................................... 32

Concept of Location Exposure Study.................................................................................... 33

Representation of Conceptual Framework............................................................................. 34

Materials and Methods..................................................................................... 35

Study Background...................................................................................................... 35

Data Source.................................................................................................................... 35

Variables........................................................................................................................ 35

Data Preparation........................................................................................................ 36

Software and Assumptions................................................................................................. 36

Sample Creation.............................................................................................................. 37

Location Data................................................................................................................. 37

Data Filtering and Variable Selection.................................................................................. 39

Data Cleaning and Coding................................................................................................ 40

Initial Analyses.......................................................................................................... 40

Univariate Analyses.......................................................................................................... 40

Bivariate Analyses............................................................................................................ 41

Modeling...................................................................................................................... 41

Modeling and Diagnostics................................................................................................. 41

Associative Models........................................................................................................... 41

Results......................................................................................................................... 43

Descriptive Statistic Results...................................................................................... 43

Location Findings............................................................................................................ 43

Univariate Analyses.......................................................................................................... 43

Bivariate Analyses............................................................................................................ 43

Multivariate Associative Modeling Results.......................................................... 44

Modeling-Left Stroke Belt By Age 30................................................................................... 44

Modeling-Portion of Life Spent in Stroke Belt....................................................................... 45

Modeling-Age At Which One Left Stroke Belt........................................................................ 47

Discussion................................................................................................................. 49

Limitations.................................................................................................................... 53

Future Research.......................................................................................................... 54

Conclusions............................................................................................................. 55

References................................................................................................................. 58

Tables............................................................................................................................ 63

Table 1: Change In African-American Populations By Decade (In Thousands)............................ 63

Table 2: Distribution of Years In Which One Left The Stroke Belt By Decade Amongst African-Americans Born in the Stroke Belt 63

Table 3: Descriptive Statistics for Those Who Stayed in Stroke Belt v. Moved Out of Stroke Belt Amongst African-Americans Born in the Stroke Belt 64

Table 4: Descriptive statistics by Stayed in Stroke Belt v. Moved and Stroke History amongst African-Americans Born in the Stroke Belt 66

Table 5: Odds Ratios For Model 1a And Model 2aBased On Born In Stroke Belt And Stayed To At Least Age 30 Amongst African-Americans 68

Table 6: Odds Ratios For Model 3a And Model 4aBased On Born In Stroke Belt And Stayed To At Least Age 30 Amongst African-Americans 69

Table 7: Odds Ratios For Model 1b And Model 2bBased On Portion of Life Spent in Stroke Belt Amongst African-Americans Born in the Stroke Belt 71

Table 8: Odds Ratios For Model 3b And Model 4bBased On Portion of Life Spent in Stroke Belt Amongst African-Americans Born in the Stroke Belt 72

Table 9: Odds Ratios For Model 1c And Model 2cBased On Age One Left Stroke Belt Amongst African-Americans Born in the Stroke Belt 74

Table 10: Odds Ratios For Model 3c And Model 4cBased On Age One Left Stroke Belt Amongst African-Americans Born in the Stroke Belt 75

Graph 1: Distribution of Migrations Out of the Stroke Belt Amongst African-Americans Born in the Stroke Belt Amongst Study Population 77

Appendix.......................................................................................................................... I

General Etiology and Prevention of Strokes........................................................... I

Established Risk Factors...................................................................................................... I

Other Possible Factors..................................................................................................... VII

Prevention of Strokes......................................................................................................... IX

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