Functional Impairment from Stroke: an Exploratory Study of Disparities

描述（由申请人提供）：了解主要疾病发作后决定长期结果的因素是确定有效策略以改善人口健康，降低残疾患病率和消除健康差距的关键。中风是美国老年人主要残疾的主要原因。然而，由于现有数据的局限性，对卒中前社会、环境或健康特征的研究受到严重阻碍，这些特征可能会减少卒中的后果。大多数优秀的中风研究都是区域性的，并且/或者在住院和诊断时开始收集数据。很少有数据来源包括全国范围内的中风幸存者样本，从中风发作前到长期恢复期进行纵向跟踪。在仅从一个或几个社区收集的数据集中，不可能测试地理或背景风险因素对卒中结局的影响，也不可能检查种族差异是否受到这些背景因素的影响。在卒中发作时开始入组的研究中，检查卒中前风险因素通常需要回顾性数据收集。如果没有卒中前的功能评估，就很难量化卒中引起的功能下降程度。虽然在全国性前瞻性队列中收集经医学证实的卒中发作数据既困难又昂贵，但一些现有的全国性纵向研究包括自我报告的卒中。健康与退休研究（HRS）是一项针对50岁以上美国人的持续的全国代表性研究，该研究定期询问参与者中风和其他主要疾病的病史。自成立以来，HRS参与者记录了近2,500例首次卒中事件，但在使用HRS数据研究卒中结局时，误报卒中的可能性是一个问题。我们提出了三个目标：1）使用关联的医疗保险索赔记录作为金标准，量化HRS中自我报告的中风事件的测量误差; 2）检查中风对死亡率、认知障碍和其他疾病影响的国家和地区种族差异。（通过单词回忆评分和认知状态电话访谈进行评估）和身体限制（日常生活的工具性和基本活动）;和3）识别改变中风对健康影响的中风前特征。这项研究建立在HRS的非凡资源基础上，其中包括详细的社会经济指标和有价值的纵向健康数据。这一探索性项目将为HRS数据的其他应用奠定基础，包括对卒中发病率和卒中后结局决定因素的更广泛研究。这些分析还将为HRS评估的其他自我报告的医疗状况（如心脏病和糖尿病）的扩展提供模型，因此未来的工作可以检查这些疾病发作的风险因素以及确定这些疾病背景下功能水平的因素。 公共卫生相关性：我们建议使用健康与退休研究的数据，这是一项针对50岁及以上美国人的全国性纵向研究，旨在研究改善中风后功能的因素。首先，我们将比较研究参与者在访谈中描述的中风记录与他们在医疗保险索赔中的记录。其次，我们将观察中风对黑人和白色患者的影响是否相似。第三，我们将测试中风发作前测量的社会经济资源或其他特征是否会减少中风对生存，记忆和认知功能或身体独立性的影响。

DESCRIPTION (provided by applicant): Understanding factors that determine long term outcomes after the onset of major medical conditions is key to identifying effective strategies to improve population health, reduce the prevalence of disability, and eliminate health disparities. Stroke is a leading cause of major disability in elderly Americans. Yet, research into pre- stroke social, contextual, or health characteristics that may reduce the consequences of stroke has been severely hampered by limitations in available data. Most of the preeminent stroke studies are regionally localized and/or initiate data collection upon hospitalization and diagnosis. Few data sources include nationwide samples of stroke survivors followed longitudinally from prior to stroke onset through the long-term recovery period. In data sets collected from only one or a few communities, it is impossible to test the effects of geographic or contextual risk factors on stroke outcomes, or to examine whether racial disparities are modified by such contextual factors. In studies that initiate enrollment at the onset of stroke, examining pre-stroke risk factors typically requires retrospective data collection. Without pre-stroke functional assessments, it is difficult to quantify how much of a functional decrement was induced by the stroke. Although it is difficult and expensive to collect medically verified stroke onset data in a national, prospective cohort, some already existing national longitudinal studies include self-reported stroke. The Health and Retirement Study (HRS) is an ongoing, nationally representative study of Americans aged 50+ that routinely asks participants about history of stroke and other major medical conditions. Since inception, nearly 2,500 incident first strokes have been recorded for HRS participants, but the possibility of misreporting of stroke is a concern when using HRS data to study stroke outcomes. We propose three aims, 1) Quantify measurement error in self-reported incident strokes in the HRS, using linked Medicare claims records as a gold standard; 2) Examine national and regional racial disparities in the effects of stroke on mortality, cognitive impairments (assessed with word recall score and the Telephone Interview for Cognitive Status), and physical limitations (instrumental and basic activities of daily living); and 3) Identify pre-stroke characteristics that modify the effects of stroke on health. This research builds on the extraordinary resources in HRS, which includes detailed socioeconomic measures and valuable longitudinal health data. This exploratory project would lay the groundwork for other applications of HRS data, including broader research on determinants of stroke incidence and post-stroke outcomes. These analyses will also provide a model for extensions to other self-reported medical conditions assessed in HRS, such as heart disease and diabetes, so future work could examine both risk factors for onset of these diseases and factors that determine level of functioning in the context of these conditions. PUBLIC HEALTH RELEVANCE: We propose to use data from the Health and Retirement Study, a national longitudinal study of Americans aged 50 and older, to study factors that improve people's functioning after stroke. First, we will compare the stroke records that study participants describe in interviews to their records from Medicare claims. Second, we will look to see if stroke affects black and white patients similarly. Third, we will test whether socioeconomic resources or other characteristics measured before stroke onset reduce the consequences of stroke on survival, memory and cognitive functioning, or physical independence.