Disparities in Patterns of Recurrent Stroke in the Elderly

在美国，中风是一个主要的公共卫生问题，估计每年有80万人中风， 估计有700万中风幸存者。它是导致女性死亡的第三大原因和第五大原因。 因为在男人身上。20%的中风幸存者需要在3个月后接受机构护理，15%-30%的人需要 永久失能。成人中风与年龄有很强的相关性。因为美国的人口是 随着老龄化，中风风险人口将在未来几十年内增加，女性人数将超过男性 在中风事件方面。美国人口结构的另一个重要变化是有色人种女性的增加， 预计将从占美国女性总人口的36%增加到53%。改善中风 监测以填补中风负担方面的重要知识空白，研究不足、代表性不足和 被低估的女性亚群对于确定减轻女性中风负担的战略至关重要。 这一行政补充资料将建立在老年人复发性中风模式差异的基础上 家长R01拨款用于评估中风发生率和结果，以获得按服务付费和医疗保险优势 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 未得到充分研究的种族/少数民族群体中女性中风住院和预后的模式 老年医疗保险受益人的地理区域；以及2)描述中风发生率和 根据双重资格的Medicare-Medicaid状态和地理区域的结果。我们建议的研究将 解决美国国立卫生研究院妇女健康研究战略计划确定的研究重点 用于收集、共享和比较妇女疾病和状况的临床数据的信息系统 以及审查妇女由于种族/民族差异而产生的健康差距 社会经济地位。这项研究还涉及国家老龄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发展监测 了解疾病预防、进展、治疗和结果的连续体的系统， 尤其是对弱势群体而言。临床实践、公共政策和补偿决定 管理数据集提供的信息越来越多。这项研究将是最全面和最严谨的 到目前为止的调查旨在描述未得到充分研究的妇女的中风发生率和结局， 代表性不足和报告不足的人口，包括黑人/非裔美国人、拉美裔/拉美裔美国人 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。这个 研究还将检查老年医疗保险-医疗补助受益人的中风发生率和结果，其中之一 美国医疗体系中社会经济上最脆弱的人群。这样的信息是需要的 告知女性和未得到充分服务的中风患者亚群的临床管理。

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.