Etiology of Geographic and Racial Differences in Stroke

中风死亡率的地理和种族差异已经存在了50多年，每年增加的成本为46亿美元。人们提出了造成这些差异的许多原因，但现有的研究没有充分解决这些问题，干预措施也未能降低其程度。此外，没有国家数据说明认知能力下降的普遍程度，这一问题主要是由脑血管疾病及其风险因素造成的。随着对30，000名黑人和白色社区居民参与者的全国队列的招募、基线评估和随访的完成，卒中的地理和种族差异的原因（REGARDS）研究具有独特的定位，可以测试解释种族/地区差异的较旧但未经证实的假设，评估新的循证假设，并提供关于认知下降预测因子的第一个全国性数据。在本延续申请中，我们建议继续随访该队列中的卒中事件和认知下降，这将使观察到的卒中事件数量增加四倍，并提供有关认知下降的纵向数据。这些数据将提供机会，通过评估混杂因素的作用来研究卒中死亡率差异的根本原因，以介导非裔美国人和南方人中观察到的过度风险，并为相对罕见的卒中亚型（包括ICH和SAH）开发风险函数。REGARDS的初步分析表明，有一个与中风带一致的“认知下降带”。继续研究的数据将允许对这些差异的描述进行细化，并且使用用于卒中结局的类似分析方法，将提供对这些差异原因的见解。最后，我们将研究认知能力下降作为后续卒中事件预测因子的作用。这些目标的完成将允许开发干预措施，以消除中风和认知能力下降发生率的差异。实施针对黑人和白色人群以及美国各地区定制的特定干预措施，可能会减少卒中识别和治疗、风险因素预防以及现有风险因素的最佳管理方面的健康差异。

Geographic and racial disparities in stroke mortality have existed for over 50 years with an incremental annual cost of $4.6 billion. Many causes for these disparities have been proposed, but existing research has inadequately addressed these, and interventions have failed to reduce their magnitude. Further, national data are not available describing the prevalence of cognitive decline, a problem largely caused by cerebrovascular disease and its risk factors. With completion of recruitment, baseline evaluation and follow-up of a national cohort of 30,000 black and white community dwelling participants, the REasons for Geographic And Racial Differences in Stroke (REGARDS) study is uniquely positioned to test older but unsubstantiated hypotheses explaining race/region disparities, to assess new evidence-based hypotheses, and to provide the first national data on predictors of cognitive decline. In this continuation application we propose to continue follow-up for incident stroke and cognitive decline among this cohort, which will quadruple the number of observed stroke events arid provide longitudinal data on cognitive decline. These data will provide the opportunity to investigate the underlying causes of the disparities in stroke mortality by assessing the role of confounding factors to mediate the observed excess risk among African Americans and Southerners, and to develop risk functions for relatively rare stroke subtypes including ICH and SAH. Preliminary analysis from REGARDS suggests that there is a-"cognitive decline belt" that is concordant with the Stroke belt. The data from the continuation will allow a refinement of the description of these disparities, and, using similar analysis approaches employed for the stroke outcomes, will provide insights into the causes for these disparities. Finally, we will investigate the role of cognitive decline as a predictor for subsequent stroke events. Completion of these aims will allow for development of interventions to eliminate disparities in the incidence of stroke and cognitive decline. Implementation of specific interventions customized for black and white populations, and by region of the United States, may reduce health disparities in stroke recognition and treatment, risk factor prevention, and optimal management of existing risk factors.