Disparities in Patterns of Recurrent Stroke in the Elderly

老年人复发性中风模式的差异

• 批准号: 9911542
• 负责人: JUDITH H LICHTMAN
• 金额: $ 23.45万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-04-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9911542
• 关键词: Address; Administrative Supplement; Adult; African American; Aging; Alaska Native; American; American Heart Association; American Indians; American Stroke Association; Asian Americans; Caring; Carotid Endarterectomy; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic; Clinical Data; Clinical Management; Color; Data; Data Reporting; Data Set; Disabled Persons; Disease; Elderly; Ethnic Origin; Event; Fee-for-Service Plans; Female; Future; Geographic Locations; Grant; Growth; Health Insurance; Healthcare; Healthcare Systems; High Prevalence; Hispanics; Hospitalization; Information Systems; Institute of Medicine (U.S.); Investigation; Knowledge; Latino; Left; Low income; Medicaid; Medical; Medicare; Medicare/Medicaid; Minority Groups; National Institute of Neurological Disorders and Stroke; National Institute on Aging; Native Hawaiian; Outcome; Pacific Island Americans; Parents; Patient-Focused Outcomes; Pattern; Persons; Population; Populations at Risk; Procedures; Proxy; Public Health; Public Policy; Race; Recurrence; Research; Research Personnel; Research Priority; Resources; Risk; Services; Societies; Socioeconomic Status; Source; Strategic Planning; Stroke; Subgroup; System; Treatment outcome; Underrepresented Populations; United States; United States National Institutes of Health; Vulnerable Populations; Woman; Women' s Health; age related; aging population; beneficiary; care outcomes; clinical practice; cohort; cost; demographics; disability; disadvantaged population; disorder prevention; dual eligible; experience; health data; health disparity; high risk population; hospitalization rates; human old age (65+); improved; insight; low socioeconomic status; men; national surveillance; patient subsets; population based; post stroke; programs; racial and ethnic; safety net; social; socioeconomic disadvantage; socioeconomics; stem; stroke event; stroke outcome; stroke patient; stroke risk; stroke survivor; surveillance data

Stroke is a major public health problem in the United States, with an estimated 800,000 strokes each year and an estimated 7 million stroke survivors. It is the third leading cause of death in women and the fifth leading cause in men. Twenty percent of stroke survivors require institutional care after 3 months and 15%-30% are permanently disabled. Stroke in adults is strongly age dependent. Because the United States population is aging, the population at risk for stroke will increase over the coming decades, and women will outnumber men in terms of stroke events. Another important shift in the US demographics is the increase of women of color, projected to increase from 36 percent to 53 percent of the total US female population. Improving stroke surveillance to fill important knowledge gaps in the burden of stroke for understudied, underrepresented, and underreported subgroups of women is critical to identify strategies to lessen the burden of stroke for women. This administrative supplement will build upon the Disparities in Patterns of Recurrent Stroke in the Elderly parent R01 grant to assess stroke rates and outcomes for fee-for-service and Medicare Advantage beneficiaries. Medicare administrative data will be used to achieve the following specific aims: 1) To describe patterns in stroke hospitalizations and outcomes for women in understudied racial/ethnic minority groups and geographic regions among elderly Medicare beneficiaries; and 2) To describe patterns of stroke rates and outcomes according to dual-eligible Medicare-Medicaid status and geographic region. Our proposed study will address research priorities identified by the NIH Strategic Plan for Women’s Health Research to develop information systems for collecting, sharing, and comparing clinical data for diseases and conditions of women as well as to examine health disparities among women stemming from differences in race/ethnicity and socioeconomic status. The study also addresses priorities identified by the National Institute on Aging, the Institute of Medicine, and National Institute of Neurological Disorders and Stroke to develop surveillance systems to understand the continuum of disease prevention, progression, treatment, and outcomes, particularly for vulnerable populations. Clinical practice, public policy, and reimbursement decisions are increasingly informed by administrative datasets. This study will be the most comprehensive and rigorous investigation to date aimed at describing stroke rates and outcomes among women from understudied, underrepresented, and underreported populations, including Blacks/African Americans, Hispanics/Latinos, American Indians/Alaska Natives, Asian Americans, and Native Hawaiians and other Pacific Islanders. The study will also examine the stroke rates and outcomes among elderly Medicare-Medicaid beneficiaries, one of the most socioeconomically vulnerable populations in the US healthcare system. Such information is needed to inform the clinical management of women and underserved subgroups of patients with stroke.

中风是美国的一个主要公共卫生问题，估计每年有 80 万例中风， 估计有 700 万中风幸存者。它是女性第三大死因，也是第五大死因 原因在男性。 20% 的中风幸存者在 3 个月后需要机构护理，15%-30% 永久禁用。成人中风与年龄密切相关。因为美国的人口是 老龄化，未来几十年中风风险人口将增加，女性人数将超过男性 就中风事件而言。美国人口结构的另一个重要转变是有色人种女性的增加， 预计美国女性总人口的比例将从 36% 增加到 53%。改善中风 监测，以填补关于中风负担的重要知识空白，因为中风负担尚未得到充分研究、代表性不足和 报告不足的女性亚群体对于确定减轻女性中风负担的战略至关重要。 该行政补充将以老年人复发性中风模式的差异为基础 家长 R01 补助金用于评估中风发生率和按服务收费和 Medicare Advantage 的结果 受益人。医疗保险管理数据将用于实现以下具体目标： 1) 描述 未充分研究的少数种族/族裔群体中女性的中风住院模式和结果，以及 老年医疗保险受益人的地理区域； 2) 描述中风频率的模式和 根据双重资格医疗保险-医疗补助状态和地理区域的结果。我们提出的研究将 解决 NIH 妇女健康研究战略计划确定的研究重点，以制定 用于收集、共享和比较妇女疾病和状况临床数据的信息系统 以及审查由于种族/族裔差异而导致的妇女健康差异 社会经济地位。该研究还涉及国家老龄化研究所确定的优先事项 医学研究所和国家神经疾病和中风研究所开展监测 了解疾病预防、进展、治疗和结果连续性的系统， 特别是对于弱势群体。临床实践、公共政策和报销决定 越来越多地通过行政数据集获取信息。这项研究将是最全面、最严格的 迄今为止的调查旨在描述未被充分研究的女性中风发生率和结果， 代表性不足和报告不足的人群，包括黑人/非裔美国人、西班牙裔/拉丁裔， 美洲印第安人/阿拉斯加原住民、亚裔美国人、夏威夷原住民和其他太平洋岛民。这 研究还将检查老年医疗保险-医疗补助受益人的中风率和结果，这是其中之一 美国医疗保健系统中社会经济最脆弱的人群。需要此类信息 为女性和服务不足的中风患者亚群的临床管理提供信息。