SOCIAL INTEGRATION, AGING AND STROKE

社会融合、老龄化和中风

• 批准号: 6055479
• 负责人: THOMAS ANDREW GLASS
• 金额: $ 2.05万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-09-01 至 1999-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6055479
• 关键词: aging; behavioral /social science research tag; cardiovascular disorder epidemiology; clinical research; data collection; disease /disorder proneness /risk; functional ability; health services research tag; hospital utilization; human data; human mortality; human old age (65+); outcomes research; psychosocial service; quality of life; questionnaires; social psychology; social support network; stroke

DESCRIPTION: (Adapted from Investigator's Abstract) Stroke is the third leading cause of death and the leading cause of disability in the United States. Previous studies have shown a link between social networks and social supports and all-cause mortality as well as to recovery from serious illness. While several studies of social integration and cardiovascular disease have been conducted, evidence regarding the role of social integration in stroke is rare and conflicted. It is plausible that the same mechanisms linking social integration and cardiovascular disease are also involved in stroke. Previous attempts to identify this link have suffered from poor measurement of social relationships, or from inadequate statistical power. The central aim of this research is to examine the impact of social networks and social support on several stroke outcomes including incidence, mortality, case fatality, functional recovery and discharge destination. Data from three large-scale prospective cohort studies and one psychosocial intervention study will be analyzed. The four studies are: 1) the New Haven site of the EPESE study (n = 2,182); 2) the Duke EPESE site (n = 4,163); 3) the Health Professionals Follow-up Study (n = 32,624); and 4) the Families in Recovery from Stroke trial (n = 290). The five hypotheses to be tested are: 1) higher levels of social support and stronger social networks are associated with lower risk of incidence stroke among community-dwelling adults; 2) stronger social networks are associated with a lower risk of stroke mortality among community-dwelling adults; 3) higher levels of social support and stronger social networks are associated with improved functional recovery after stroke; 4) higher levels of social support and stronger social networks are associated with lower risk of all cause mortality among those who have sustained a stroke and who are discharged alive; and 5) higher levels of social support and stronger social networks are associated with a lower risk of discharge to a skilled nursing facility for long-term placement. Fatal and non-fatal strokes will be confirmed by matching with medical records, the national death index, as well as HCFA Part A Medicare data. Data gathering activities ongoing in two of the studies (HPFS and FIRST) which will lead to enhanced statistical power. The main independent variable, available in all four studies, is the Berkman-Syme Social Network Index (SNI). A range of additional measures of social support and networks will be also be utilized. A variety of statistical models will be used including: 1) Cox proportional hazards model (hypotheses 1, 2, 4); 2) OLS autoregression models (hypothesis 3); and 3) polychotomous logistic regression (hypothesis 5). Data from each study will be analyzed separately. The investigators state that the strength of this study will be the availability of substantial numbers of stroke cases across multiple studies. They further state that the proposed research will be the most comprehensive study of social integration and stroke to date, and will yield both clinically and policy relevant results. They conclude that information about how the social context impacts the etiology and course of this prevalent disease will lead to low-cost intervention strategies.

描述：（改编自研究者摘要）中风是第三种 美国死亡的主要原因和残疾的主要原因 国家。 先前的研究表明社交网络与 社会支持和全因死亡率以及从严重疾病中恢复 疾病。 虽然一些关于社会融合和心血管疾病的研究 已经进行了疾病研究，有关社会作用的证据 中风的整合很少见，而且是相互矛盾的。 看来同样是有道理的 社会融合与心血管疾病之间的联系机制也被证实 参与中风。 之前尝试识别此链接的尝试均遭遇失败 由于对社会关系的衡量不善或不充分 统计功效。 这项研究的中心目的是检验 社交网络和社会支持对几种中风结果的影响 包括发病率、死亡率、病死率、功能恢复和 卸货目的地。 来自三个大规模前瞻性队列的数据 将分析一项研究和一项心理社会干预研究。 四个 研究包括： 1) EPESE 研究的纽黑文地点 (n = 2,182)； 2） 杜克大学 EPESE 站点（n = 4,163）； 3) 卫生专业人员跟踪研究 (n = 32,624）； 4) 中风康复家庭试验（n = 290）。 这 需要检验的五个假设是：1）更高水平的社会支持和 更强大的社交网络与更低的中风发病风险相关 在社区居住的成年人中； 2）关联更强大的社交网络 社区居住的成年人中风死亡的风险较低； 3） 更高水平的社会支持和更强大的社交网络是相关的 中风后功能恢复得到改善； 4）更高的社会层次 支持和更强大的社交网络与所有人的风险降低有关 导致中风患者死亡 活着出院； 5）更高水平的社会支持和更强的社会力量 网络与出院接受熟练护理人员的较低风险相关 长期安置设施。 致命和非致命中风将通过与医学匹配来确认 记录、国家死亡指数以及 HCFA A 部分医疗保险数据。 其中两项研究（HPFS 和 FIRST）正在进行数据收集活动 这将增强统计能力。 主要独立 所有四项研究中都存在的变量是 Berkman-Syme 社交网络 指数（SNI）。 一系列额外的社会支持和网络措施 也将被利用。 将使用多种统计模型 包括： 1）Cox比例风险模型（假设1、2、4）； 2）最小最小二乘法 自回归模型（假设3）； 3）多分逻辑 回归（假设 5）。 将分析每项研究的数据 分别地。 研究人员表示，这项研究的优势在于 多个国家/地区存在大量中风病例 研究。 他们进一步指出，拟议的研究将是最 迄今为止对社会融合和中风的全面研究，并将产生 临床和政策相关的结果。 他们的结论是，信息 关于社会背景如何影响其病因和过程 流行疾病将导致低成本干预策略。