Psychosocial Factors & Stroke Risk in a Biracial Population

描述(申请人提供)：中风死亡率是美国第三大主要死亡原因，也是导致长期残疾的主要原因。已经确定了几个中风风险因素，但心理社会因素在中风风险中的作用还知之甚少。抑郁症状、敌意和应激状态与心血管疾病(CVD)相关，但这些因素与中风发病率和死亡率之间的关系大多缺乏系统的研究。我们建议对心理社会危险因素与卒中发生率和死亡率之间的关系进行前瞻性分析，重点放在一组公认的和新的心血管疾病心理社会危险因素的综合集合上。我们将在对老年黑人和(非西班牙裔)白人的一项基于人口的研究中检查这些风险因素。与白人相比，黑人中风的风险几乎是白人的两倍，而且往往具有明显更不利的心理社会风险特征。这项拟议的工作将利用美国国立卫生研究院资助的芝加哥健康和老龄化项目(CHAP；RO1AG11101)的现有数据，该项目正在进行中，对阿尔茨海默病和与年龄相关的慢性病的风险因素进行纵向研究。通过家长CHAP研究，我们可以访问联邦医疗保险索赔文件和死亡率数据，以确定拟议研究的结果。这是一个极好的机会，可以利用丰富和独特的数据源，以高成本效益的方式解决有关高危人群中中风风险的重要研究问题。我们提出了三个具体目标：1)确定心理社会危险因素(抑郁症状、感知到的压力、敌意和感知到的歧视)是否与中风事件和中风死亡率的增加相关；2)确定生活在有压力的社区是否会增加发生中风和中风死亡的可能性；以及3)比较黑人和白人在中风风险上的差异，并检查心理社会风险因素在多大程度上调节中风风险的种族差异。其次，我们将进行敏感性分析，以检查心理社会因素与缺血性中风风险、从接受详细结构化临床访谈或MRI扫描的CHAP参与者中临床诊断的中风，以及MRI识别的脑白质高信号以及皮质和皮质下梗死之间的关系。这项拟议的研究将确定中风的潜在可改变危险因素，因此对未来的中风预防工作具有重要的潜力。

DESCRIPTION (provided by applicant): Stroke mortality is the 3rd leading cause of death in the U.S. and a leading cause of long-term disability. Several stroke risk factors have been identified, but the role of psychosocial factors in stroke risk is poorly understood. Depressive symptoms, hostility, and stressful conditions are associated with cardiovascular diseases (CVD), but systematic investigation of these factors in relation to stroke incidence and mortality has been mostly lacking. We propose to conduct a prospective analysis of the relationship between psychosocial risk factors and stroke incidence and mortality, focusing on a comprehensive set of both well-established and novel psychosocial risk factors for CVD. We will examine these risk factors in a population-based study of older Blacks and (non-Hispanic) Whites. Blacks have almost double the risk of incident stroke compared with Whites and tend to have a significantly more adverse psychosocial risk profile. The proposed work will take advantage of existing data from the NIH-funded Chicago Health and Aging Project (CHAP; RO1 AG11101), an ongoing, longitudinal study of risk factors for Alzheimer's disease and age-related chronic conditions. Through the parent CHAP study, we have access to Medicare Claims files and mortality data to ascertain outcomes for the proposed study. This is an excellent opportunity to utilize a rich and unique data source to address important research questions on stroke risk in an at-risk population in a highly cost-effective manner. We propose 3 specific aims: 1) to determine whether psychosocial risk factors (depressive symptoms, perceived stress, hostility, and perceived discrimination) are associated with increased risk of incident stroke and stroke mortality; 2) to determine whether living in stressful neighborhoods increases the likelihood of incident stroke and stroke mortality; and 3) to compare Blacks and Whites on risk for stroke and examine the degree to which racial differences in stroke risk are mediated by psychosocial risk factors. Secondarily, we will conduct sensitivity analyses to examine the association of psychosocial factors and risk of ischemic strokes, clinically diagnosed stroke from the subset of CHAP participants who have undergone detailed structured clinical interviews or MRI scans, and MRI-identified white matter hyperintensities and cortical and subcortical infarcts. The proposed study stands to identify potentially modifiable risk factors for stroke and thus has important potential for future efforts in stroke prevention.