Etiology of Geographic and Racial Differences in Stroke

描述(由申请人提供)：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。造成这些差异的原因有很多，但现有的研究没有充分解决这些问题，干预措施也未能减少这些差异的程度。此外，没有国家数据描述认知能力下降的流行率，这一问题主要由脑血管疾病及其风险因素引起。随着对30,000名黑人和白人社区居住参与者的全国队列的招募、基线评估和后续行动的完成，中风的地理和种族差异原因研究(CONTS)具有独特的地位，可以测试解释种族/地区差异的旧的但未经证实的假设，评估新的基于证据的假设，并提供关于认知能力下降预测因素的第一个全国性数据。在这项延续应用中，我们建议继续对这一队列中的偶发中风和认知下降进行随访，这将使观察到的中风事件的数量翻两番，并提供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调查中风死亡率差异的根本原因，以调节在非裔美国人和南方人中观察到的额外风险，并开发相对罕见的中风亚型的风险函数，包括ICH和SAH。来自ARES的初步分析表明，存在一条与中风带相一致的“认知衰退带”。延续的数据将允许对这些差异的描述进行细化，并使用对中风结果采用的类似分析方法，将为这些差异的原因提供洞察力。最后，我们将调查认知功能衰退对后续中风事件的预测作用。完成这些目标将允许制定干预措施，以消除中风发病率和认知能力下降的差异。实施针对黑人和白人人群并按美国不同地区定制的特定干预措施，可能会减少中风识别和治疗、风险因素预防和现有风险因素最佳管理方面的健康差距。

DESCRIPTION (provided by applicant): 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.