Modifiable risk factors in stroke incidence and mortality among women

女性中风发病率和死亡率的可改变危险因素

• 批准号: 8178676
• 负责人: Sophia S Wang
• 金额: $ 24.34万
• 依托单位: BECKMAN RESEARCH INSTITUTE/CITY OF HOPE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8178676
• 关键词: Accounting; Address; Adolescence; Adult; Affect; Age; Anthropometry; Behavioral; Body fat; Body mass index; California; Cause of Death; Cessation of life; Clinical Trials; Cohort Studies; Communities; Complex; Data; Diabetes Mellitus; Diagnosis; Drug Formulations; Epidemic; Estrogens; Etiology; Evaluation; Exposure to; Female; Foundations; Future; Health; Health behavior; Height; Hip region structure; Hospitalization; Hospitals; Hypertension; Incidence; Intervention; Joints; Knowledge; Life; Life Cycle Stages; Link; Longevity; Measures; Menopause; Obesity; Outcome; Overweight; Participant; Pattern; Pharmaceutical Preparations; Phenotype; Physical activity; Population; Population Attributable Risks; Postmenopause; Prevalence; Prevention strategy; Procedures; Progestin Therapy; Public Health; Questionnaires; Recommendation; Recording of previous events; Research; Research Infrastructure; Resources; Risk; Risk Factors; Schools; Solid; Stroke; Stroke prevention; Taxes; Time; United States; Weight; Weight Gain; Woman; Women' s Health; abdominal fat; base; cohort; disorder risk; energy balance; follow-up; high school; hormone therapy; insight; modifiable risk; mortality; prospective; public health relevance; repository; sedentary; teacher; time use

DESCRIPTION (provided by applicant): Stroke is the third leading cause of death in the United States (U.S.) and women account for 60% of all deaths from stroke. Major shifts in modifiable exposures over the past decade - increasing obesity and physical inactivity and decreasing menopausal hormone therapy (MHT) use - are changing the profile of women's health, but their effect on stroke among women is unclear. The California Teachers Study (CTS), a prospective cohort study that has actively followed 133,479 female California public school professionals for a broad range of health outcomes since 1995, is poised to evaluate how these societal transitions in modifiable exposures affect incidence of and mortality from stroke. The unique repository of life course exposure data on modifiable risk factors in the CTS cohort provides a near-singular resource for prospective assessment of women's health risks associated with long-term history of physical activity, longitudinal anthropometry data on body fat distribution, and detailed MHT use. Our specific aims address the impact of these shifting exposures both individually and together on stroke incidence and mortality, both overall and among the two major stroke subtypes (ischemic and hemorrhagic). In Aim 1, we will determine the impact of obesity and physical inactivity on the rates, risk, and population attributable fraction of incident and fatal stroke. Our detailed questionnaires permit us to evaluate the effect of lifelong and changing patterns of obesity phenotypes (defined as a combination of temporal changes in overall adiposity with adult body fat distribution) and physical activity, including by age and recency. In Aim 2, we will determine whether the effects on rates, risk and population attributable fraction observed from obesity and physical inactivity (Aim 1) become more pronounced in the years following widespread cessation of MHT use (after 2002). To accomplish these aims, we will calculate age-adjusted and age-specific annual incidence and mortality rates, standardized to the U.S. population in 2000. To calculate risk associations, we will use time-dependent exposure data on these key exposures from teenage years to old age and analyze associations with stroke risk and mortality using statistical approaches that account for missing data and secular changes in exposures. We will calculate the population attributable fraction for each etiologic risk factor, and by time period when MHT was widely used versus the recent sharp decline in use. Public Health Relevance: Successful completion of these aims will permit evaluation of the population impact of a decade of profound transition in obesity, physical activity, and MHT use on women's stroke incidence and mortality, and provide insight into the interplay between these and other relevant exposures. This proposal focuses on the etiology of stroke incidence and causes of stroke mortality and emphasizes common, modifiable, behavioral risk factors in ways that can facilitate future population-wide stroke prevention efforts. PUBLIC HEALTH RELEVANCE: The California Teachers Study spans more than a decade of profound transitions in women's health behaviors, including increasing physical inactivity and obesity, and decreasing use of hormone therapy. By examining how exposures to these common, modifiable risk factors over a woman's lifespan influences rates and risk of stroke incidence and mortality, this study will provide critical new knowledge that can serve as the basis for behavioral public health interventions that benefit women on a population-wide scale.

描述（由申请人提供）：中风是美国（美国）的第三大死亡原因，妇女占中风死亡的60％。在过去的十年中，可改变的暴露率的重大转变 - 增加肥胖症和身体不活跃，减少更年期激素疗法（MHT）的使用 - 正在改变妇女健康状况的特征，但妇女对中风的影响尚不清楚。自1995年以来，加利福尼亚教师研究（CTS）是一项前瞻性队列研究，该研究已积极遵循133,479名加利福尼亚公立学校专业人士的健康成果，并有望评估这些社会过渡如何在可修改的暴露型中影响中风的发生率和死亡率。 CTS队列中有关可修改风险因素的生命课程暴露数据的独特存储库为预期评估与体育锻炼的长期历史，纵向人体脂肪分布的长期历史相关的妇女健康风险的预期资源提供了资源。我们的具体目的涉及这些转移暴露的影响，无论是整体上以及两个主要的中风子类型（缺血性和出血性）中的中风发生率和死亡率的影响。在AIM 1中，我们将确定肥胖和身体不活动对事件和致命中风的率，风险和人口的影响。我们的详细问卷使我们能够评估肥胖表型的终生和变化模式的影响（定义为整体肥胖与成人体内脂肪分布的时间变化的结合）和体育活动，包括年龄和新近度。在AIM 2中，我们将确定在MHT使用广泛停止后的几年中，对肥胖和身体不活跃的速率，风险和人口的影响（AIM 1）是否变得更加明显（2002年之后）。为了实现这些目标，我们将计算出年龄调整和特定年龄的年度发病率和死亡率，该年龄在2000年对美国人口进行标准化。为了计算风险关联，我们将使用这些关键暴露数据对这些关键暴露数据进行这些关键暴露数据，从青少年年龄到老年到老年，并使用统计上的统计数据来计算缺失数据和偏差的统计数据，并分析与遇到的统计数据相关的相关性。我们将计算每个病因学风险因素的归因分数，到MHT被广泛使用与最近使用的急剧下降时。公共卫生相关性：这些目标的成功完成将允许评估肥胖，体育活动和MHT使用对妇女中风发生率和死亡率的十年过渡的人口影响，并提供对这些与其他相关暴露之间相互作用的见解。该提议着重于中风发生率和中风死亡率的病因，并以促进未来范围内人口预防的方式的方式强调常见，可修改的行为风险因素。 公共卫生相关性：加利福尼亚教师的研究跨越了十多年的妇女健康行为过渡，包括增加身体不活动和肥胖以及减少对激素治疗的使用。通过检查对这些常见的，可修改的危险因素的暴露如何影响女性的寿命，影响中风发生率和死亡率的风险，这项研究将提供关键的新知识，这些知识可以作为行为公共卫生干预措施的基础，这些干预措施使女性受益于人口范围。