Infection and Stroke in Mexican Americans

中风是美国成年人的第三大死亡原因和主要残疾原因。每年有近80万人中风，超过14.3万人因此死亡。拉美裔美国人是美国增长最快的少数族裔人口，也是人数最多的少数民族。大多数拉美裔美国人都是墨西哥裔。墨西哥裔美国人(MA)中风的风险增加，特别是在残疾影响最大的年轻时期。MAS卒中风险增加的原因尚不完全清楚，但传统的危险因素不太可能完全解释这一人群中卒中负担的增加。慢性感染性病原体被认为是卒中的危险因素和卒中预后差的危险因素，尽管证据仍然不确定，而且还没有在MA进行的研究。由于慢性感染在MA中比他们的非西班牙裔白人更普遍，这一风险因素可能对这一人群特别重要。这项拟议的论文研究试图在萨克拉门托地区拉丁裔老龄化研究(SALSA)的参与者中检查慢性感染与卒中事件和卒中后功能结局之间的联系。这项研究将在几个关键方面扩展目前对感染和中风的认识：1)通过检查对几种感染源的抗体反应与感染血清状态作为中风的独立风险因素，2)通过研究抗体反应可能影响中风风险的潜在机制，包括炎症途径，3)通过调查抗体反应与中风后功能结果的关联，以及4)通过专门关注已知经历更大的中风负担和更大的感染负担的MA人群。在考虑了传统的危险因素后，认识到感染增加了中风的风险，这可能对在MA中预防中风和缩小这一人群中的中风健康差距具有重要意义。除了促进这一关键领域的科学研究外，拟议的研究金还将提供所需的严格培训，包括课程作业和研讨会/讲习班，与中风神经学家和流行病学家的互动，以及将申请者从博士生发展为独立调查员所需的基于人群的研究和实验室方法的动手培训，后者将把她的研究生涯致力于中风及其决定因素的研究，包括感染。

Stroke is the third leading cause of death and leading cause of disability in adults in the US. Nearly 800,000 people suffer a stroke annually, and more than 143,000 deaths occur as a result. Hispanic Americans are the fastest growing minority population in the US, as well as the most numerous. The majority of Hispanic Americans are of Mexican descent. Mexican Americans (MAs) have an increased risk of stroke especially at younger ages when disability has the greatest impact. Reasons for increased stroke risk in MAs are not fully understood but traditional risk factors are not likely to fully account for the increased stroke burden in this population. Chronic infectious pathogens have been proposed as risk factors for stroke and for poor stroke outcome, although the evidence remains inconclusive and studies have not been done in MAs. As chronic infections are more prevalent in MAs than their non-Hispanic white counterparts, this risk factor may be particularly important for this population. The proposed dissertation research seeks to examine the links between chronic infection and incident stroke and post-stroke functional outcome, among participants from the Sacramento Area Latino Study on Aging (SALSA). This research will extend current knowledge of infection and stroke in several critical ways:1) by examining antibody response to several infectious agents versus infection serostatus as independent risk factors for stroke, 2) by examining the underlying mechanisms, including inflammatory pathways, by which antibody response may influence stroke risk, 3) by investigating the association of antibody response to post-stroke functional outcomes and 4) by focusing specifically in a MA population known to experience a greater stroke burden as well as a greater infection burden. The recognition that infection increases stroke risk after accounting for traditional risk factors may have important implications for the prevention of stroke in MAs and for reducing the stroke health disparity in this population. In addition to advancing the science in this critical area, the proposed fellowship will provide the rigorous training, including coursework and seminars/workshops, interaction with stroke neurologists and epidemiologists and hands-on training in population-based studies and laboratory methods, needed to develop the applicant from a doctoral student to an independent investigator who will devote her research career to the study of stroke and its determinants, including infection.