Reducing Racial Disparities in Post-Stroke Disability in the Elderly

描述(申请人提供)：中风很常见，每年发生近800,000例中风，是美国残疾的主要原因。非西班牙裔黑人/非裔美国人(黑人)成年人中风患病率最高，中风后残疾程度也是美国所有种族/民族中最高的。尽管中风后残疾的种族差异很普遍，但人们对如何缩小这种差异知之甚少。残疾方面的种族差异 这些差异发生在中风后时期；然而，尚不清楚这些差异是在中风后不久的早期恢复期、许多中风幸存者正在接受康复治疗时出现的，还是在中风幸存者返回社区后出现的。该项目将解决中风后残疾的种族差异何时出现的关键问题，并确定在ECH时期这种差异的驱动因素。回答这些问题是设计干预措施以改善黑人中风幸存者的健康并减少差异的关键一步。为了解决这些问题，我们将依靠最新可用的国家健康和老龄化趋势研究(NHATS)，该研究与医疗保险索赔和功能评估数据有关。NHATS是一项针对医疗保险受益人的全国性纵向调查，重点是了解老年人残疾的原因和后果。NHATS每年进行面对面的访谈，仔细描述老年人的残疾特征，并衡量包括社会、社区和残疾适应因素在内的大量残疾预测因素。此外，NHATS与医疗保险索赔的联系将使衡量重要的医疗和康复因素成为可能，这些因素也可能解释中风后残疾的种族差异。这些数据来源将被用来制定所有康复环境--家庭健康、门诊、熟练护理和住院康复--的康复强度的第一个综合衡量标准，比较不同种族的康复强度，并估计康复强度对残疾差异的影响。在完成 研究将确定中风后残疾的种族差异的时间和车手。此外，我们新的康复强度测量方法可以作为一个原型，用于研究康复在其他疾病中的作用，如创伤性脑损伤和关节炎。 这项提案特别响应了NIMHD的邀请，因为它侧重于可修改的 从政策的角度分析中风后残疾的种族差异的驱动因素，并将直接为中风幸存者和家庭一级减少残疾和减少差异的战略提供信息。

DESCRIPTION (provided by applicant): Stroke is common, nearly 800,000 strokes occur annually, and a leading cause of disability in the U.S. Non-Hispanic Black/African American (Black) adults have the highest stroke prevalence and suffer the most post-stroke disability of any U.S. racial/ethnic group. Even though racial disparities in post-stroke disability are widespread, little it is known about how to reduce this disparity. Racial differences in disability arise in the post-stroke period; however it is unclear if these differences arise shortly after strke in the early recovery period, when many stroke survivors are undergoing rehabilitation, or after stroke survivors return to the community. This project will address the critical questions of when racial disparities in post-stroke disability arise and determine the drivers of this disparity in ech period. Answering these questions is an essential step to designing interventions to improve health in Black stroke survivors and reduce disparities. To address these questions, we will rely on the newly available National Health and Aging Trends Study (NHATS) linked to Medicare claims and functional assessment data. NHATS is a national, longitudinal survey of Medicare beneficiaries focused on understanding the causes and consequences of disability in the elderly. NHATS performs annual face-to-face interviews to carefully characterize disability in the elderly and measures a vast array of disability predictors including social, community and disability accommodation factors. Additionally NHATS's linkage to Medicare claims will enable measurement of important medical and rehabilitation factors that may also explain racial differences in post-stroke disability. These data sources will be used to develop the first comprehensive measures of rehabilitation intensity across all rehabilitation settings-home health, outpatient, skilled nursing and inpatient rehabilitation-compare intensity by race and estimate the effect of rehabilitation intensity on disability disparities. At the completion of the study, the timing and drivers of race differences in post-stroke disability will be identified. Furthermore, our novel measures of rehabilitation intensity can serve as a prototype for use in studying the role of rehabilitation in other diseases such as traumatic brain injury and arthritis. This proposal is particularly responsive to the NIMHD solicitation in that it focuses on modifiable drivers of racial differences in post-stroke disability from a policy standpoint and will directly inform stroke survivor and family level strategies to reduce disability and decrease disparities.