Disparities in Patterns of Recurrent Stroke in the Elderly

老年人复发性中风模式的差异

基本信息

批准号：
10737282
负责人：
JUDITH H LICHTMAN
金额：
$ 59.99万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-04-01 至 2027-04-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10737282
关键词：
Address Adult Age Aging American American Heart Association American Stroke Association Area Cardiovascular system Caring Cause of Death Cessation of life Characteristics Clinical Communities County Data Data Set Databases Diagnostic tests Disabled Persons Disease Disparity Elderly Event Family Fee-for-Service Plans Geographic Locations Goals Grant Guidelines Health Health Insurance Health Resources Health Status Healthcare Systems Heart Diseases Heterogeneity High Prevalence Hospitalization Inequity Institute of Medicine (U.S.)Institution Insurance Carriers Intervention Investigation Ischemic Stroke Link Longterm Follow-up Medicare Modeling Neurologic Deficit Outcome Patient-Focused Outcomes Patients Pattern Policy Maker Population Populations at Risk Prevention strategy Public Health Public Policy Recovery Recurrence Reporting Research Personnel Resources Risk Role Societies Socioeconomic Status Source Stroke Subgroup System Time United States Variant adverse outcome age related aging demographic aging demography beneficiary cardiovascular health cardiovascular risk factor care providers clinical practice community-level factor comorbidity cost data resource disability disparity elimination follow-up functional disability health care availability health disparity high risk human old age (65+)improved mortality national surveillance patient subsets population based post stroke prevent programs residence sociodemographic disparity sociodemographic factors sociodemographics stroke event stroke incidence stroke outcome stroke risk stroke survivor trend vascular risk factor

项目摘要

Project Summary/Abstract Stroke is a major public health problem in the United States. It is the fifth leading cause of death and a leading cause of serious disability in adults. There are an estimated 800,000 strokes in the United States each year, with more than 7.6 million stroke survivors. Twenty percent of stroke survivors require institutional care after 3 months and 15%-30% are permanently disabled. Stroke in adults is strongly age dependent, and the rate of adverse outcomes and complications associated with stroke increases with advanced age. Because the United States population is aging, the population at risk for stroke, recurrent stroke events, and other post-stroke outcomes will increase over the coming decades. Its high prevalence, associated deficits, and adverse outcomes impose a large burden on patients, their families, and the healthcare system. Stroke survivors are at high risk of new diseases due to their functional disability, neurological deficits, and pre-existing cardiovascular risk factors and comorbidities. The proposed renewal application builds on the Original R01 (Disparities in Patterns of Recurrent Stroke in the Elderly study) to expand our extensive patient-linked surveillance database to provide invaluable information on patterns and trends of 1-, 5-, and 10-year outcomes after ischemic stroke. We will combine Medicare fee-for-service and Medicare Advantage administrative data for 2017 to 2024 to accomplish the following specific aims: 1) to assess national and county-level rates and trends in 1-year outcomes for Medicare Advantage and fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors from 2017 to 2024; 2) to assess 5-year outcomes for Medicare Advantage and fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors, clinical characteristics, and geographic location from 2017 to 2024; and 3) to assess 5-year and 10- year outcomes for Medicare fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors and region from 2001 to 2024. Clinical practice, public policy, and reimbursement decisions are increasingly informed by data obtained from administrative datasets. The proposed study will be the largest contemporary investigation of recurrent stroke rates, post-stroke events, and long-term follow-up of Medicare beneficiaries hospitalized with ischemic stroke in the United States. Results from this project will identify geographic areas and subgroups that have distinctive health profiles that put them at high risk for adverse outcomes after stroke. Such information will inform care providers, insurers, public health agencies, and policy makers about communities that may derive the greatest benefit from targeted programs and community-based interventions.

项目摘要/摘要中风是美国的主要公共卫生问题。这是死亡的第五个主要原因，也是领导成人严重残疾的原因。每年美国估计有80万中风有超过760万中风幸存者。二十％的中风幸存者需要机构护理3 月数和15％-30％永久残疾。成年人中风的年龄很大，率与中风相关的不良结果和并发症随着年龄的增长而增加。因为曼联州人口正在老龄化，中风的风险，反复中风事件和其他后冲程结果将在未来几十年中提高。其高流行率，相关的赤字和不利结果对患者，家人和医疗保健系统造成了很大的负担。中风幸存者在由于其功能障碍，神经功能缺陷和预先存在的心血管疾病，新疾病的高风险风险因素和合并症。拟议的续约应用程序建立在原始R01上（在老年研究中，复发性中风的模式）扩展了我们广泛的患者关联监视数据库提供有关缺血性中风后1、5和10年结局的模式和趋势的宝贵信息。我们将结合2017年至2024年的Medicare费用服务和Medicare Advantage行政数据完成以下具体目标：1）评估1年的国家和县级利率和趋势具有缺血性中风的医疗保险优势和收费服务受益人的成果从2017年到2024年，社会人口统计学因素的差异； 2）评估Medicare的5年成果优势和支付服务受益人的缺血性中风，并通过社会人口统计学描述差异从2017年到2024年的因素，临床特征和地理位置； 3）评估5年和10-- 具有缺血性中风的医疗保险费用受益人的一年成果，并通过从2001年到2024年的社会人口统计学因素和地区。临床实践，公共政策和报销从管理数据集获得的数据越来越多地告知决策。拟议的研究将是对复发率，中风后事件和长期随访的当代最大的研究美国的医疗保险受益人在美国有缺血性中风住院。这个项目的结果将确定具有独特健康状况的地理区域和亚组，使它们处于高风险中风后的不利结果。这些信息将为护理提供者，保险公司，公共卫生机构提供通知，以及有关社区的政策制定者，这些社区可能会从目标计划中获得最大的收益，基于社区的干预措施。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Association of short-term hospital-level outcome metrics with 1-year mortality and recurrence for US Medicare beneficiaries with ischemic stroke.

DOI：
10.1371/journal.pone.0289790
发表时间：
2023
期刊：
PloS one
影响因子：
3.7
作者：
通讯作者：

Outcomes after ischemic stroke for dual-eligible Medicare-Medicaid beneficiaries in the United States.

DOI：
10.1371/journal.pone.0292546
发表时间：
2023
期刊：
PLOS ONE
影响因子：
3.7
作者：
Leifheit, Erica C.;Wang, Yun;Goldstein, Larry B.;Lichtman, Judith H.
通讯作者：
Lichtman, Judith H.

Associations Between Long-Term Air Pollutant Exposure and 30-Day All-Cause Hospital Readmissions in US Patients With Stroke.

美国中风患者长期接触空气污染物与 30 天全因医院再入院之间的关系。

DOI：
10.1161/strokeaha.122.042265
发表时间：
2023
期刊：
Stroke
影响因子：
8.3
作者：
Tran,PhoebeM;Warren,JoshuaL;Leifheit,EricaC;Goldstein,LarryB;Lichtman,JudithH
通讯作者：
Lichtman,JudithH

Disparities in Internet Use Among US Stroke Survivors: Implications for Telerehabilitation During COVID-19 and Beyond.