Living (and Dying) in the Stroke Belt and the Implications for Workers’ Compensation

Living (and Dying) in the Stroke Belt and the Implications for Workers’ Compensation

 By Thomas A. Robinson

In the South, we take great pride in a form of perverse magic: we can turn a green vegetable into a stroke. It's pretty simple, really. You take some freshly picked okra, wash it, slice it in half-inch sections, dip the sections in buttermilk, dredge them in corn meal that's been seasoned with liberal amounts of salt and crushed black & red pepper, and fry the morsels in bacon fat until they're golden brown. The taste is incredible. Repeat the procedure regularly for several decades and it's also deadly. Fried okra, fried squash, fried fish, even fried grits—it's the food I was raised on. It's the food I've been trying unsuccessfully to wean myself from for the past several decades. It's the food that I try to counter each morning with Lisinopril (for hypertension) and a low dose aspirin (to help “thin” my blood). It's the food of the “Stroke Belt.”

The Medical Side of the Stroke Belt

I recently had lunch with Brian Caveney, M.D., J.D., MPH, Assistant Professor of Medicine, Duke University Medical School (Division of Occupational and Environmental Medicine). Dr. Caveney also serves as Editor-in-Chief of Occupational Injuries and Illnesses (LexisNexis). In the interest of full disclosure: we both had salads, although I was certainly tempted by the fried perch and catfish platter. I wanted to gain a better understanding of the incidence of stroke and the relevant risk factors among my Stroke Belt colleagues and neighbors. I also wanted to pick his brain regarding some of the workers' compensation implications associated with elevated stroke rates among workers in the Stroke Belt.

Dr. Caveney initially reminded me that stroke is the third leading cause of death and the leading cause of serious, long-term disability in the United States. He indicated that by far the most common type is ischemic stroke, when the blood supply to part of the brain is cut off by a clot or other obstruction and that the less common variety, hemorrhagic strokes, occurs when there is bleeding into brain tissue, resulting in brain tissue damage. In spite of the fact that the temperature outside the restaurant was in the high 90’s and the heat index hovered at 110º, we did not include within our discussion medical emergencies commonly referred to as “heat strokes”—those unfortunate total collapses associated with strenuous activity under extremely hot, humid conditions. We talked about the fact that strokes occur throughout the year—not just when it's hot—that strokes are problematic in all parts of the United States, but that they are particularly prevalent within the so-called Stroke Belt.

Dr. Caveney indicated that while there is no unanimity among medical experts as to the states included on this less-than-auspicious Stroke Belt list, at least the following seven states are included: Alabama, Arkansas, Georgia, Mississippi, North Carolina, South Carolina, and Tennessee. Caveney advised that within that geographic belt, incidence of strokes is between 1.3 and 2.0 times the national average and that some medical specialists insist that there's actually a “stroke belt” within the Stroke Belt, since the incidence of strokes is even higher among residents of the coastal plain of North Carolina, South Carolina, and Georgia.

Dr. Caveney further indicated that while perhaps three-quarters of the excess numbers of strokes in the South can be explained by diet and other societal factors—if mama's cooking included significant amounts of fried food, fatty meat, whole milk and heavy cream, one is usually drawn to such “comfort” foods throughout one's life—at least a quarter of the excess numbers of strokes in the Stroke Belt cannot adequately be explained. Studies have tried to pinpoint some substance within the region's water supply, some soil condition, or some other factor that might explain the number of strokes that cannot otherwise be associated with southern diet and genetic predispositions, but experts have not been able to identify the mystery factor. Whatever that factor might be, it seems to manifest itself in the first decade or so of life; excess risk of stroke mortality associated with living in the Stroke Belt is apparent even among people who were born in the Stroke Belt but who move to other parts of the nation by their mid-teen years, indicates Dr. Caveney.

Workers’ Compensation Implications

What does fried okra have to do with workers' compensation law? Actually, quite a bit, since under workers' compensation law, an employer generally takes the employee as it finds him or her. To find out how a preexisting disease or infirmity—e.g., clogged arteries, hypertension, diabetes, and obesity—does not generally disqualify a claim under the “arising out of employment” requirement if the employment aggravates, accelerates, or combines with the disease or infirmity to produce death or disability, purchase the complete article by Thomas A. Robinson here at the LexisNexis Bookstore.

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