Disparities in Patterns of Recurrent Stroke in the Elderly

项目总结/摘要 中风是美国的一个主要公共卫生问题。它是第五大死亡原因，也是第一大死亡原因。 成年人严重残疾的原因。据估计，美国每年有80万人中风， 超过760万中风幸存者。20%的中风幸存者在3岁后需要机构护理 15%-30%是永久性残疾。成年人的中风具有很强的年龄依赖性， 与中风相关的不良结局和并发症随着年龄的增长而增加。因为联合 国家人口正在老龄化，有中风风险的人口，复发性中风事件，和其他中风后 在未来几十年中，成果将增加。它的高患病率，相关的缺陷， 结果给患者、其家庭和医疗保健系统带来巨大负担。中风幸存者在 由于功能残疾、神经缺陷和既存心血管疾病， 危险因素和合并症。建议的续期申请以原始R 01（ 老年人复发性卒中模式研究），以扩展我们广泛的患者相关监测数据库 提供缺血性卒中后1年、5年和10年结局的模式和趋势的宝贵信息。 我们将结合2017年至2024年的联合收割机医疗保险按服务收费和医疗保险优势管理数据， 实现以下具体目标：（1）评估国家和县级一年内的比率和趋势 Medicare Advantage和按服务收费的缺血性卒中受益人的结局，并描述 2017年至2024年社会人口因素的差异; 2）评估医疗保险的5年结果 缺血性卒中受益者的优势和按服务收费的受益者，并描述社会人口统计学差异 2017年至2024年的因素、临床特征和地理位置; 3）评估5年和10年的 缺血性卒中的Medicare按服务收费受益人的年结果，并描述了以下方面的差异： 2001年至2024年的社会人口因素和区域。临床实践、公共政策和报销 决策越来越多地参考从行政数据集获得的数据。拟议的研究将 当代最大的卒中复发率、卒中后事件和长期随访的研究， 美国因缺血性中风住院的医疗保险受益人。该项目的成果将 确定具有独特健康状况的地理区域和亚组，使他们处于高风险， 中风后的不良后果。这些信息将告知护理提供者、保险公司、公共卫生机构， 和政策制定者关于社区，可能会获得最大的利益，从有针对性的计划， 基于社区的干预。

Project Summary/Abstract Stroke is a major public health problem in the United States. It is the fifth leading cause of death and a leading cause of serious disability in adults. There are an estimated 800,000 strokes in the United States each year, with more than 7.6 million stroke survivors. Twenty percent of stroke survivors require institutional care after 3 months and 15%-30% are permanently disabled. Stroke in adults is strongly age dependent, and the rate of adverse outcomes and complications associated with stroke increases with advanced age. Because the United States population is aging, the population at risk for stroke, recurrent stroke events, and other post-stroke outcomes will increase over the coming decades. Its high prevalence, associated deficits, and adverse outcomes impose a large burden on patients, their families, and the healthcare system. Stroke survivors are at high risk of new diseases due to their functional disability, neurological deficits, and pre-existing cardiovascular risk factors and comorbidities. The proposed renewal application builds on the Original R01 (Disparities in Patterns of Recurrent Stroke in the Elderly study) to expand our extensive patient-linked surveillance database to provide invaluable information on patterns and trends of 1-, 5-, and 10-year outcomes after ischemic stroke. We will combine Medicare fee-for-service and Medicare Advantage administrative data for 2017 to 2024 to accomplish the following specific aims: 1) to assess national and county-level rates and trends in 1-year outcomes for Medicare Advantage and fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors from 2017 to 2024; 2) to assess 5-year outcomes for Medicare Advantage and fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors, clinical characteristics, and geographic location from 2017 to 2024; and 3) to assess 5-year and 10- year outcomes for Medicare fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors and region from 2001 to 2024. Clinical practice, public policy, and reimbursement decisions are increasingly informed by data obtained from administrative datasets. The proposed study will be the largest contemporary investigation of recurrent stroke rates, post-stroke events, and long-term follow-up of Medicare beneficiaries hospitalized with ischemic stroke in the United States. Results from this project will identify geographic areas and subgroups that have distinctive health profiles that put them at high risk for adverse outcomes after stroke. Such information will inform care providers, insurers, public health agencies, and policy makers about communities that may derive the greatest benefit from targeted programs and community-based interventions.