Cardiovascular Disease Prevalence in Non-Hispanic Blacks: U.S. Territories vs. Stroke Belt and Non-Stroke Belt States

INTRODUCTION: Extensive research exists on the increased prevalence of cardiovascular disease (CVD) in the "Stroke Belt" states, compared to the remaining United States (U.S.). Social, environmental, and systemic factors and individual behaviors have been investigated, including Black race. This study aims to assess whether residing in the U.S. territories, Stroke Belt, or non-Stroke Belt states is associated with differences in CVD prevalence among non-Hispanic Black adults. METHODS: We analyzed cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System (BRFSS). All non-Hispanic Black adults (18+) with complete information on key variables, including demographics, CVD outcomes, and relevant risk factors, were included. The prevalence of CVD was defined as self-reported coronary artery disease, stroke, or myocardial infarction. Univariate and multivariable logistic regression analyses were used to calculate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Results: Of the 31,246 individuals included in our study, 87 (8.7%) residing in the U.S. territories reported experiencing a cardiovascular event, compared to 1487 (10.1%) in the Stroke Belt and 1872 (8.2%) in the non-Stroke Belt regions. Compared to non-Hispanic Black adults residing outside the Stroke Belt, those living in the Stroke Belt had 23% higher odds of reporting CVD (OR 1.23, 95% CI 1.10-1.44) after adjusting for age and gender. In the fully adjusted model, which accounted for additional factors such as comorbidities and socioeconomic status, the odds were slightly attenuated but remained elevated (OR 1.14, 95% CI 0.97-1.35). For Black adults living in the U.S. territories, the odds of reporting CVD were not significantly different from those outside the Stroke Belt in both the age- and gender-adjusted model (OR 1.07, 95% CI 0.66-1.73) and the fully adjusted model (OR 0.93, 95% CI 0.49-1.74). Independent of residence, individuals with high blood pressure (OR 2.85, 95% CI 2.05-3.96), diabetes (OR 1.45, 95% CI 1.20-1.75), and high cholesterol (OR 1.55, 95% CI 1.27-1.89) had significantly higher odds of CVD. In contrast, smoking and income were associated with prevalent CVD, while self-reported diet, physical activity, and education level were not. CONCLUSION: Contrary to our expectation, we found that non-Hispanic Black adults residing in the U.S. territories had similar self-reported CVD with those living in the non-Stroke Belt regions. Further research is needed to investigate the socio-behavioral factors influencing cultural and historical disparities among non-Hispanic Black individuals in the U.S. and its territories.