SOCIAL INTEGRATION, AGING AND STROKE

社会融合、老龄化和中风

• 批准号: 6533791
• 负责人: THOMAS ANDREW GLASS
• 金额: $ 11.99万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 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 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6533791
• 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：（根据调查员的摘要改编）中风是第三个 死亡的主要原因和统一残疾的主要原因 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认真恢复 疾病。 而社会融合和心血管的几项研究 已经进行了疾病，有关社会作用的证据 中风中的整合很少见。 相同的是合理的 连接社会融合和心血管疾病的机制也是 参与中风。 以前识别此链接的尝试已经遭受 来自社会关系的衡量不佳或不足 统计能力。 这项研究的核心目的是检查 社交网络和社会支持对几个中风结果的影响 包括发病率，死亡率，病例死亡，功能恢复和 出院目的地。 来自三个大型前瞻性队列的数据 将分析研究和一项社会心理干预研究。 四个 研究是：1）Epese研究的纽黑文（New Haven）（n = 2,182）； 2） 杜克Epese地点（n = 4,163）; 3）卫生专业人员后续研究（n = 32,624）; 4）从中风试验中恢复的家庭（n = 290）。 这 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较低的入射率风险有关 在社区成年人中； 2）更强大的社交网络是相关的 在社区居民中，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 中风后功能恢复的改善； 4）更高的社会水平 支持和更强大的社交网络与所有人的风险较低有关 导致那些持续中风的人死亡 活着出院； 5）更高水平的社会支持和更强大的社会 网络与熟练护理的排放风险较低有关 长期安置的设施。 致命的和非致命的中风将通过与医疗匹配来确认 记录，国家死亡指数以及HCFA A部分Medicare数据。 在两项研究中正在进行的数据收集活动（HPF和首先） 这将导致增强的统计能力。 主要独立 在所有四项研究中都可以使用的变量是伯克曼 - 苏姆社交网络 索引（SNI）。 一系列社会支持和网络的措施 也将被利用。 将使用各种统计模型 包括：1）COX比例危害模型（假设1，2，4）； 2）OLS 自动锻炼模型（假设3）；和3）多接值 回归（假设5）。 每个研究的数据将进行分析 分别地。 调查人员指出，这项研究的力量将是 多个跨多个中风案件的可用性 研究。 他们进一步指出，拟议的研究将是最大的 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。 他们得出结论 关于社会环境如何影响病因和过程 普遍的疾病将导致低成本的干预策略。