Patterns of Recurrent Stroke in the Elderly

在美国，中风是一个主要的公共卫生问题。它是第五大死因，也是 成人严重残疾的主要原因。据估计，美国每年有80万人中风 去年，有440多万中风幸存者。20%的中风幸存者需要机构护理 3个月后，15%-30%的人永久残疾。发生在185,000例中风中的复发性事件 美国每年的幸存者，与更高的死亡率，更高的残疾水平， 而且与第一次击打相比，成本更高。成年人中的中风与年龄密切相关，而中风的发生率 与中风相关的不良后果和并发症随着年龄的增加而增加。因为美联队 各州人口正在老龄化，中风和复发事件的风险人口在未来将会增加 几十年。它的高患病率和相关的缺陷给患者、他们的家人和 医疗保健系统。优化卒中幸存者的急性后护理和二级预防工作 是减轻中风复发负担的一个重要目标，尤其是在老年人中。种族- 已经确定了中风发病率、患病率和死亡率的种族和地区差异，但相对 很少有研究关注复发中风事件模式的潜在差异。的模式。 老年复发性卒中研究将使用医疗保险管理数据实现以下具体 目的：1)确定老年医疗保险受益人因缺血性中风住院的复发率 并根据地理和社会人口特征评估复发率的差异；以及2) 确定社会经济、医疗保健可获得性、生活方式/合并症和急性后护理因素 导致反复发生的中风事件的变化。临床实践、公共政策和补偿决策 从行政数据集获得的数据越来越多地提供信息。中国复发性卒中的发病模式 这项老年研究将是当代最大的关于中风复发几率和模式的调查 美国。该项目的结果将确定具有鲜明特色的地理区域和子组 健康状况使他们再次中风的风险很高。这样的信息将通知护理提供者， 保险公司、公共卫生机构和政策制定者关于可能获得最大好处的社区 从有针对性的项目和基于社区的干预中受益。

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 4.4 million stroke survivors. Twenty percent of stroke survivors require institutional care after 3 months and 15%-30% are permanently disabled. Recurrent events, which occur in 185,000 stroke survivors in the United States each year, are associated with higher mortality rates, greater levels of disability, and increased costs as compared with first strokes. 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 and recurrent events will increase over the coming decades. Its high prevalence and associated deficits impose a large burden on patients, their families, and the healthcare system. Optimizing post-acute care and secondary prevention efforts for stroke survivors represents an important target to reduce the burden of recurrent stroke, particularly among the elderly. Racial- ethnic and regional disparities have been identified for stroke incidence, prevalence, and morality, but relatively little research has focused on potential disparities in the patterns of recurrent stroke events. The Patterns of Recurrent Stroke in the Elderly Study will use Medicare administrative data to achieve the following specific aims: 1) to determine rates of recurrent stroke in elderly Medicare beneficiaries hospitalized with ischemic stroke and assess disparities in recurrent rates by geographic and sociodemographic characteristics; and 2) to identify socioeconomic, healthcare access, lifestyle/comorbidity, and post-acute care factors that may contribute to variation in recurrent stroke events. Clinical practice, public policy, and reimbursement decisions are increasingly informed by data obtained from administrative datasets. The Patterns of Recurrent Stroke in the Elderly Study will be the largest contemporary investigation of recurrent stroke rates and patterns 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 recurrent 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.