Psychosocial Factors & Stroke Risk in a Biracial Population

描述（由申请人提供）：中风死亡率是美国第三大死亡原因，也是导致长期残疾的主要原因。一些中风危险因素已经被确定，但是社会心理因素在中风危险中的作用却知之甚少。抑郁症状、敌意和压力状况与心血管疾病（CVD）有关，但对这些因素与卒中发病率和死亡率的关系的系统调查大多缺乏。我们建议对心理社会危险因素与卒中发病率和死亡率之间的关系进行前瞻性分析，重点关注心血管疾病的一整套成熟和新的心理社会危险因素。我们将在一项以老年黑人和（非西班牙裔）白人为基础的人群研究中检查这些危险因素。与白人相比，黑人患突发中风的风险几乎是白人的两倍，而且往往有更严重的不良心理风险。拟议的工作将利用美国国立卫生研究院资助的芝加哥健康与老龄化项目（CHAP; RO1 AG11101）的现有数据，这是一项正在进行的阿尔茨海默病和年龄相关慢性疾病风险因素的纵向研究。通过父CHAP研究，我们可以访问医疗保险索赔文件和死亡率数据，以确定拟议研究的结果。这是一个极好的机会，利用丰富而独特的数据源，以高成本效益的方式解决高危人群中风风险的重要研究问题。我们提出了3个具体目标：1)确定社会心理风险因素（抑郁症状、感知压力、敌意和感知歧视）是否与卒中发生率和卒中死亡率增加有关；2)确定生活在压力大的社区中是否会增加卒中发生率和卒中死亡率；3)比较黑人和白人的中风风险，并研究种族差异在多大程度上受心理社会风险因素的调节。其次，我们将进行敏感性分析，以检查社会心理因素与缺血性卒中风险的关联，从经过详细结构化临床访谈或MRI扫描的CHAP参与者子集中临床诊断的卒中，以及MRI识别的白质高信号和皮质和皮质下梗死。这项研究旨在确定中风的潜在可改变的危险因素，因此对未来预防中风的努力具有重要的潜力。

DESCRIPTION (provided by applicant): Stroke mortality is the 3rd leading cause of death in the U.S. and a leading cause of long-term disability. Several stroke risk factors have been identified, but the role of psychosocial factors in stroke risk is poorly understood. Depressive symptoms, hostility, and stressful conditions are associated with cardiovascular diseases (CVD), but systematic investigation of these factors in relation to stroke incidence and mortality has been mostly lacking. We propose to conduct a prospective analysis of the relationship between psychosocial risk factors and stroke incidence and mortality, focusing on a comprehensive set of both well-established and novel psychosocial risk factors for CVD. We will examine these risk factors in a population-based study of older Blacks and (non-Hispanic) Whites. Blacks have almost double the risk of incident stroke compared with Whites and tend to have a significantly more adverse psychosocial risk profile. The proposed work will take advantage of existing data from the NIH-funded Chicago Health and Aging Project (CHAP; RO1 AG11101), an ongoing, longitudinal study of risk factors for Alzheimer's disease and age-related chronic conditions. Through the parent CHAP study, we have access to Medicare Claims files and mortality data to ascertain outcomes for the proposed study. This is an excellent opportunity to utilize a rich and unique data source to address important research questions on stroke risk in an at-risk population in a highly cost-effective manner. We propose 3 specific aims: 1) to determine whether psychosocial risk factors (depressive symptoms, perceived stress, hostility, and perceived discrimination) are associated with increased risk of incident stroke and stroke mortality; 2) to determine whether living in stressful neighborhoods increases the likelihood of incident stroke and stroke mortality; and 3) to compare Blacks and Whites on risk for stroke and examine the degree to which racial differences in stroke risk are mediated by psychosocial risk factors. Secondarily, we will conduct sensitivity analyses to examine the association of psychosocial factors and risk of ischemic strokes, clinically diagnosed stroke from the subset of CHAP participants who have undergone detailed structured clinical interviews or MRI scans, and MRI-identified white matter hyperintensities and cortical and subcortical infarcts. The proposed study stands to identify potentially modifiable risk factors for stroke and thus has important potential for future efforts in stroke prevention.