Functional Impairment from Stroke: an Exploratory Study of Disparities

描述(由申请人提供)：了解决定重大疾病发生后长期结果的因素是确定有效战略以改善人口健康、降低残疾发生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，由于现有数据的限制，对中风前的社会、背景或健康特征的研究可能会减少中风的后果，这一研究受到了严重的阻碍。大多数卓越的中风研究都是地区性的和/或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，从中风发病前到长期恢复期进行纵向跟踪。在只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中风结果的影响，也不可能检查种族差异是否被这些背景因素改变。在中风发病时就开始登记的研究中，检查中风前的危险因素通常需要回溯性的数据收集。如果没有卒中前的功能评估，就很难量化中风导致的功能减退的程度。虽然在全国性的前瞻性队列中收集经医学验证的卒中发病数据是困难和昂贵的，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)是一项正在进行的、具有全国代表性的研究，对象是50岁以上的美国人，该研究定期询问参与者中风史和其他主要健康状况。自成立以来，HRS参与者已经记录了近2500次事件首次中风，但当使用HRS数据研究中风结果时，错误报告中风的可能性是一个令人担忧的问题。我们提出了三个目标，1)量化HRS中自我报告的事件中风的测量误差，将相关的医疗保险索赔记录作为金标准；2)检查中风对死亡率、认知障碍(通过单词回忆分数和认知状态电话访谈评估)和身体限制(日常生活工具和基本活动)的影响方面的国家和地区种族差异；以及3)确定改变中风对健康影响的中风前特征。这项研究建立在HRS的非凡资源之上，其中包括详细的社会经济措施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，包括对中风发病率和中风后结局决定因素的更广泛研究。这些分析还将为扩展到在HRS中评估的其他自我报告的医疗状况提供一个模型，例如心脏病和糖尿病，因此未来的工作可以检查这些疾病发病的风险因素和决定这些状况下功能水平的因素。 公共卫生相关性：我们建议使用健康和退休研究的数据，这是一项针对50岁及以上美国人的全国性纵向研究，以研究中风后改善人们功能的因素。首先，我们将比较研究参与者在采访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人患者的影响是否相似。第三，我们将测试中风发病前测量的社会经济资源或其他特征是否会降低中风对生存、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.