Etiology of Geographic and Racial Differences in Stroke

描述（由申请人提供）：中风是所有慢性病中种族差异最大的，地域差异也存在，而且这两种差异的程度都在增加。令人震惊的是，REGARDS已经记录了认知能力下降的种族和地域差异，其程度与中风相同。对这些差异的原因缺乏了解，直接导致无法减少或消除这些差异。REGARDS是一项全国性队列研究，在2003-2007年期间，共有30,239名年龄在45岁以上的黑人和白人参加。我们建议利用队列来建立迄今为止的发现，并扩展我们的发现来评估新的假设。REGARDS旨在记录卒中和认知障碍发生率的差异，并了解这些差异存在的原因。我们建议进行第二次面对面评估，以确定卒中危险因素的发生率和进展。我们将继续确定中风，使中风事件的数量增加一倍，并提高我们确定导致迄今“无法解释”的中风差异的因素的能力。通过持续的认知评估，增加对认知功能和日常生活工具活动的更敏感的亲自测量，我们将推进对认知衰退差异的原因和临床相关性的理解。我们提出以下具体目标：具体目标1：在9年的随访中量化卒中危险因素的发生率和严重程度的变化，并确定这些危险因素的种族和地理差异的原因。具体目标2：评估可能解释“无法解释”差异的三种途径：a)风险因素的差异影响，其中相同的风险因素变化对一个种族的风险增加程度高于另一个种族；b)风险因素特征不完整造成的残留混淆；c)“新型”中风风险因素，包括社会心理和行为因素。具体目标#3：测量认知障碍的功能影响，估计10年随访期间认知障碍的患病率和发病率，并通过收集有关功能表现和单词阅读能力的新信息来解释由于读写能力导致的认知方面的种族差异。

DESCRIPTION (provided by applicant): Stroke has the largest racial disparity of any chronic disease, Geographic disparities also exist, and the magnitude of both disparities is increasing. Alarmingly, REGARDS has documented racial and geographic disparities in cognitive decline that are of the same magnitude as for stroke. A lack of understanding of the causes of these disparities has contributed directly to the failure to reduce or eliminate them. REGARDS is a national cohort of 30,239 black and white community-dwelling participants aged 45+ when enrolled in 2003-2007. We propose to utilize the cohort to build on findings to date and extend our findings to evaluate new hypotheses. REGARDS is positioned to document disparities in incidence of stroke and cognitive impairment and also to understand why these disparities exist. We propose to conduct a second in-person evaluation to define incidence and progression of stroke risk factors. We will continue stroke ascertainment to double the number of stroke events and improve our ability to define factors contributing to the as yet "unexplained" stroke disparities. By continuing cognitive assessments, and adding more sensitive in-person measures of cognitive function, and instrumental activities of daily living, we will advance the understanding of causes and clinical relevance of disparities in cognitive decline. We propose the following specific aims: ¿ Specific Aim #1: to quantify incidence of, and change in severity of stroke risk factors over 9 years of follow-up, and to establish causes for racial and geographic disparities in these risk factors. ¿ Specific Aim #2: to evaluate three pathways that may account for "unexplained" disparities: a) differential impact of risk factors where the same change in risk factor increases risk more for one race than the other, b) residual confounding from incomplete characterization of risk factors, and c) "novel" stroke risk factors including psychosocial and behavioral factors. ¿ Specific Aim #3: Measure the functional impact of cognitive impairment, estimate the prevalence and incidence of cognitive impairment over 10 years of follow-up, and account for racial disparities in cognition attributable to literacy by gathering new information on functional performance and word reading ability.