EPIDEMIOLOGY OF STROKE IN BIRACIAL POPULATIONS

尽管中风的负担不成比例地落在黑人身上， 我们关于中风风险因素的大部分信息都来自研究 仅限于白人群体。这项研究计划详细说明了一套 相互关联的次级项目，旨在更好地了解 混血人群中中风的决定因素。 该建议基于五个假设： 1.中风死亡率的非黑即白差异是由于 高血压患病率和严重程度更高； 2.中风死亡率的非黑即白差异主要是由于 在黑人中中风发病率更高，而不是 病死率较高； 3.中风的风险因素在黑白分明的情况下运作相似 但是，由于危险因素的分布不同， 在比赛之间，与每一场比赛相关联的中风百分比 黑人和白人的风险因素不同； 4.卒中亚型及脑内定位的差异 黑人和白人之间的动脉粥样硬化可以用以下方式解释 已知风险因素分布的差异。 5.年轻人的中风没有得到充分的解释 已确定的危险因素的分布，如高血压， 糖尿病和心脏损害。 为了验证这些假设，我们提出了六个子项目。第一，风险 中风死亡率的因素将在筛查中进行研究 多危险因素干预试验。第二，风险因素 中风发病率将在《国家健康与健康》杂志上进行研究 营养检查调查流行病学随访研究。 第三，中风病例死亡率的种族差异将是 在NINCDS卒中数据库中学习。第四，病例对照 巴尔的摩混血人群中中风的研究将是 主要关注高血压、脂蛋白 异常和葡萄糖代谢。第五，这些相同的风险 因素将与位置和严重程度相关 血管造影术定义的脑血管疾病。此外， 以人口为基础的病例确定系统的开发 年轻的中风被提出了。这一资源将用于探索 年轻人中风发病率不成比例的原因 黑人，并进行不太好的病例对照研究 已确定的风险因素。 这些项目将为优化冲程的设计做出贡献 为我们人口的所有群体制定预防战略。

Although the burden of stroke falls disproportionately on blacks, most of our information on stroke risk factors comes from studies in white populations only. This research plan details a set of interrelated subprojects aimed at a better understanding of the determinants of stroke in biracial populations. The proposal is based on five hypotheses: 1. The black-white difference in stroke mortality is due to a greater prevalence and severity of hypertension; 2. The black-white difference in stroke mortality is due primarily to a higher incidence of stroke among blacks rather than to a higher case-fatality rate; 3. Risk factors for stroke operate similarly in black and white populations but, because the distribution of risk factors differs between the races, the percentage of strokes associated with each risk factor differs between blacks and whites; 4. The differences in stroke subtypes and localization of cerebral atherosclerosis between blacks and whites is explainable by differences in the distribution of known risk factors. 5. Stroke in the young is not adequately explained by the distribution of established risk factors such as hypertension, diabetes and cardiac impairment. To test these hypotheses six subprojects are proposed. First, risk factors for stroke mortality will be studied in the screenees of the Multiple Risk Factor Intervention Trial. Second, risk factors for stroke incidence will be studied in the National Health and Nutrition Examination Survey Epidemiologic Followup Study. Third, racial differences in stroke case-fatality rates will be studied in the NINCDS Stroke Data Bank. Fourth, a case-control study of stroke in the biracial population of Baltimore will be developed focusing primarily on hypertension, lipoprotein abnormalities and glucose metabolism. Fifth, these same risk factors will be correlated with location and severity of angiographically defined cerebrovascular disease. In addition, the development of a population-based case ascertainment system for young strokes is proposed. This resource would be used to explore the reasons for the disproportionate stroke rate among young blacks, and to conduct case-control studies of less well established risk factors. These projects will contribute to the design of optimal stroke prevention strategies for all segmets of our population.