Etiology of Geographic and Racial Differences in Stroke

中风的地理和种族差异的病因学

• 批准号: 7912389
• 负责人: George Howard
• 金额: $ 36.63万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-24 至 2011-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7912389
• 关键词: Address; African American; Age; Alabama; Ancillary Study; Arkansas; Biological; Biological Assay; Biological Markers; Blood Vessels; Brain Infarction; Cerebrovascular Disorders; Cerebrum; Cognitive; Cohort Studies; Communities; Complement component C1s; Data; Diabetes Mellitus; Documentation; Epidemiology; Etiology; Evaluation; Event; Funding; Future; Health; High Prevalence; Hypertension; Impaired cognition; Incidence; Infarction; Insulin; Intervention; Laboratories; Link; Louisiana; Low Prevalence; Magnetic Resonance Imaging; Measurement; Measures; Mediating; Mississippi; Modification; North Carolina; Outcome; Participant; Pattern; Performance; Population; Positioning Attribute; Predisposition; Prevalence; Prevention; Process; Race; Reasons for Geographic And Racial Differences in Stroke; Research; Research Personnel; Risk; Risk Factors; Role; Sampling; South Carolina; Stroke; Subarachnoid Hemorrhage; Tennessee; Testing; Time; United States; Vascular Diseases; cognitive change; cognitive function; cohort; cost; epidemiology study; evidence base; follow-up; geographic difference; health disparity; improved; insight; insulin sensitivity; interest; mortality; programs; racial difference; repository; therapy development

DESCRIPTION (provided by applicant): Geographic and racial disparities in stroke mortality have existed for over 50 years with an incremental annual cost of $4.6 billion. Many causes for these disparities have been proposed, but existing research has inadequately addressed these, and interventions have failed to reduce their magnitude. Further, national data are not available describing the prevalence of cognitive decline, a problem largely caused by cerebrovascular disease and its risk factors. With completion of recruitment, baseline evaluation and follow-up of a national cohort of 30,000 black and white community dwelling participants, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study is uniquely positioned to test older but unsubstantiated hypotheses explaining race/region disparities, to assess new evidence-based hypotheses, and to provide the first national data on predictors of cognitive decline. In this continuation application we propose to continue follow-up for incident stroke and cognitive decline among this cohort, which will quadruple the number of observed stroke events arid provide longitudinal data on cognitive decline. These data will provide the opportunity to investigate the underlying causes of the disparities in stroke mortality by assessing the role of confounding factors to mediate the observed excess risk among African Americans and Southerners, and to develop risk functions for relatively rare stroke subtypes including ICH and SAH. Preliminary analysis from REGARDS suggests that there is a-"cognitive decline belt" that is concordant with the Stroke belt. The data from the continuation will allow a refinement of the description of these disparities, and, using similar analysis approaches employed for the stroke outcomes, will provide insights into the causes for these disparities. Finally, we will investigate the role of cognitive decline as a predictor for subsequent stroke events. Completion of these aims will allow for development of interventions to eliminate disparities in the incidence of stroke and cognitive decline. Implementation of specific interventions customized for black and white populations, and by region of the United States, may reduce health disparities in stroke recognition and treatment, risk factor prevention, and optimal management of existing risk factors.

描述（由申请人提供）：中风死亡率的地理和种族差异已存在 50 多年，每年增加 46 亿美元的成本。人们提出了造成这些差异的许多原因，但现有研究未能充分解决这些问题，干预措施也未能降低其严重程度。此外，没有国家数据来描述认知能力下降的患病率，这一问题主要是由脑血管疾病及其危险因素引起的。随着对 30,000 名黑人和白人社区住宅参与者的全国队列的招募、基线评估和随访的完成，卒中地理和种族差异的原因 (REGARDS) 研究具有独特的优势，可以测试解释种族/地区的较旧但未经证实的假设差异，评估新的基于证据的假设，并提供关于认知能力下降预测因素的第一个全国数据。在此延续申请中，我们建议继续跟踪该队列中的中风事件和认知能力下降，这将使观察到的中风事件数量增加四倍，并提供认知能力下降的纵向数据。这些数据将提供机会，通过评估混杂因素在调节非裔美国人和南方人中观察到的过度风险的作用来调查中风死亡率差异的根本原因，并为相对罕见的中风亚型（包括 ICH 和 SAH）开发风险函数。 REGARDS的初步分析表明，存在一条与中风带一致的“认知衰退带”。后续数据将允许对这些差异的描述进行细化，并且使用用于中风结果的类似分析方法，将提供对这些差异的原因的见解。最后，我们将研究认知能力下降作为后续中风事件预测因素的作用。完成这些目标将有助于制定干预措施，以消除中风和认知能力下降的发病率差异。实施针对黑人和白人以及美国各地区定制的具体干预措施，可以减少中风识别和治疗、危险因素预防以及现有危险因素的最佳管理方面的健康差异。