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，每年的增量成本为46亿美元。已经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，干预措施也未能减少其规模。此外，没有描述认知能力下降流行程度的国家数据，认知能力下降主要是由脑血管疾病及其危险因素引起的。随着30,000名黑人和白人社区参与者的招募、基线评估和随访的完成，中风地理和种族差异的原因（REGARDS）研究具有独特的定位，可以检验解释种族/地区差异的较早但未经证实的假设，评估新的循证假设，并提供第一个关于认知能力下降预测因子的国家数据。在这一持续应用中，我们建议继续对该队列中的卒中事件和认知能力下降进行随访，这将使观察到的卒中事件数量增加四倍，并提供有关认知能力下降的纵向数据。这些数据将提供机会，通过评估混杂因素在介导非裔美国人和南方人观察到的过度风险中的作用，调查卒中死亡率差异的潜在原因，并开发相对罕见的卒中亚型（包括脑出血和SAH）的风险函数。初步分析表明，脑卒中带与认知衰退带是一致的。来自续篇的数据将允许对这些差异的描述进行细化，并且，使用卒中结果的类似分析方法，将提供对这些差异的原因的见解。最后，我们将研究认知能力下降作为后续中风事件预测因子的作用。完成这些目标将允许开发干预措施，以消除卒中发病率和认知能力下降方面的差异。实施针对黑人和白人人群以及美国不同地区的特定干预措施，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。

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.