Etiology of Geographic and Racial Differences in Stroke

“中风带”是美国东南部的一个中风地区 死亡率比全国其他地区高出约25%，并包含 中风死亡率更高的地区(“中风扣”)。还有，非洲人 美国人中风死亡率比白人高50%。有很多 关于这些地理和种族死亡率过高的假设，但 几乎没有数据来评估原因。这项提议将解决缺乏 多个层次的信息。地理和种族差异在 作为导致不同死亡率的因素，发病率和病例死亡率将 接受检查。地理和种族差异的患病率很大 风险因素的范围，以及地理和种族差异 对这些因素的易感性，将被估计。移民的影响 将对地区之间的关系进行评估。最后，候选基因的作用 将对中风患者的地理和种族差异进行评估。 这项研究将在全国范围内招募30,000名无中风患者 年龄在55岁以上。三分之一(1/3)的参与者将来自中风 皮带，1/3来自中风扣，1/3来自美国其他地区。在 地区，一半的参与者将是非裔美国人，一半的白人和一半的人 男性和1/2女性。将确定参与者的风险因素状态 通过电话采访、家访和来自地理信息系统的数据。这群人将 对于突发中风事件，前瞻性随访3年。这 前瞻性队列设计提供了许多优势，包括直接 评估发病率和病死率，并允许评估 卒中事件发生前评估的危险因素的作用。本研究 阐述了中风死亡率过高的各种假设原因 在美国东南部和非裔美国人中，并将提供 关于设计干预措施以降低#年超额卒中死亡率的信息 这些种群。

The "Stroke Belt" is an area in the Southeastern US with stroke mortality rates approximately 25% above the rest of the nation, and contains a region of even higher stroke mortality (the "Stroke Buckle"). Also, African American stroke mortality is 50% higher than in whites. There are many hypotheses concerning these geographic and racial excesses in mortality, but little data to assess the causes. This proposal will address the lack of information at many levels. The role of geographic and racial differences in incidence and casefatality as contributors to differential mortality rates will be examined. Geographic and racial differences in the prevalence of a wide range of risk factors, and geographic and racial differences in the susceptibility to these factors, will be estimated. The impact of migration between regions will be evaluated. Finally, the role of candidate genes for stroke on the geographic and racial differences in stroke will be assessed. This study will recruit a nationwide cohort of 30,000 stroke-free participants over the age of 55. One-third (1/3) of the participants will be from the Stroke Belt, 1/3 from the Stroke Buckle, and 1/3 from the rest of the US. Within regions, 1/2 of the participants will be African American and 1/2 white and 1/2 male and 1/2 female. The risk factor status of participants will be established by a telephone interview, an inhome visit, and from GIS data. The cohort will be prospectively followed for 3 years for incident stroke events. This prospective cohort design offers many advantages including the direct assessment of incidence and case-fatality, and permitting the assessment of the role of risk factors that were evaluated prior to the stroke event. This study addresses the wide range of hypothesized causes of the excess stroke mortality in the Southeastern US and among African Americans, and will provide information to design interventions to reduce the excess stroke mortality in these populations.