Ancel Keys Lecture

One of the 2 key goals of the Healthy People 2010 statement, the guiding document for the United States Department of Health and Human Services, is to “eliminate health disparities among different segments of the population” by the year 2010.1 The US Congress has by law directed National Institutes of Health (NIH) to specifically define health disparities to include the components:For brevity, we focus on a review of the magnitude of the disparities in stroke of only the first 2 of these disparities: review progress in reducing these disparities, and assess barriers and opportunities to reduce these disparities.Racial differences in stroke mortality are the most well-known and well documented of the stroke disparities.3–5 Among non-Hispanics aged between 45 and 64 years, in 2009, there were 4359 deaths from stroke and an age-adjusted death rate of 48.9 per 100 000 in blacks, whereas there were 9994 deaths and a death rate of 16.3 per 100 000 in whites; this represents a 3-fold difference in death rates.6 There would have been ≈3000 fewer deaths for blacks in this 20-year age range if they had the mortality rate of whites (4359×(16.3/48.9)=1424 projected deaths for a reduction of 2935 deaths). If the case-fatality rate is 20%, then these 3000 deaths would have arisen from ≈15 000 extra stroke events (3000/0.2=15 000), and a public health burden of the racial disparity in stroke is ≈$2.1 billion dollars annually (assuming a $140 000 cost of stroke).7The racial disparity in stroke mortality has been remarkably persistent, where between 1949 and 1951 the nonwhite (primarily blacks)/white stroke mortality ratio was 1.63 for men …