Prenatal influences on stroke mortality in England and Wales

Background and Purpose-Within Britain and the United States there are geographic variations in mortality from stroke that are not explained by differences in adult lifestyle. We report on the geographic distribution of stroke mortality in England and Wales and compare it with that in the United States. Methods-Data from 4 studies are presented. The geographic distribution of stroke deaths in England and Wales during 1968-1978 is compared with the distribution of (1) other causes of death during the same years, (2) neonatal and maternal mortality during 1911-1925, (3) average adult height, and (4) place of birth. Results-Areas of England and Wales with high stroke mortality were characterized in the past by poor living standards, demonstrated by high infant and maternal mortality rates and short stature in the adult population. People who were born in areas of high stroke mortality rather than migrating into them are at high risk. Stroke mortality is not geographically correlated with past postneonatal mortality independently of neonatal or maternal mortality. The geographic distribution of stroke mortality in the United States and England and Wales has features in common. Conclusions-Stroke may originate through maternal influences associated with poverty. This conclusion is supported by recent findings that rates of stroke in adult life are higher among people who had low birth weight.