Comparison of Hemorrhagic & Ischemic Stroke Among Blacks and Whites

 描述（由申请人提供）：我们寻求在1，368，604名双胞胎大都市人口（其中223，417人（16.3%）为黑人）中继续开展基于人群的卒中发病率和病死率、风险因素患病率、卒中治疗和卒中后结局研究（美国人口普查2010）。拟议的工作将涉及2014/2015年本地区预计约3,750例中风和/或短暂性脑缺血发作患者，2015-2018年估计约600例复发性中风（在2014/2015年最初事件发生后3年内发生所有中风和短暂性脑缺血发作），以及2,000名调查参与者。 近20年来，我们研究了中风发病率和病死率的趋势，并证明了种族差异，非洲裔美国人的中风发病率是白人的两倍多。在之前的每个研究期间，我们还通过人群调查检查了风险因素（和卒中知识）的患病率，以便将我们的时间趋势结果置于背景中。 除了继续这些重要的活动之外，我们还试图以基于人群的方式检查卒中复发（自20世纪90年代以来尚未进行），目的是确定卒中复发是否存在种族差异。我们提出了一个创新的试点研究，以确定我们是否可以估计功能的结果和居住地在3个月和6个月后中风没有病人接触，使用当地的健康信息交换（HIE）和电子健康记录。我们将把我们的估计数与作为“黄金标准”的电话访谈进行比较;将使用的电话访谈在本报告所述期间已成功试行。最后，我们使用我们的数据来告知中风临床试验的资格。我们建议为此目的与科学界分享我们的数据。在我们提出的工作中，我们将获得有关急性卒中表现的数据，并将增加有关卒中复发和卒中后功能结局的信息，这些信息可用于合理规划卒中所有阶段（急性、二级预防、恢复）的卒中干预措施。 在所有拟议的活动中，HIE的使用将使拟议的工作成为可能（利用集中式健康数据的力量），并且对于有效地完成工作非常重要。总的来说，我们拟议的研究将在更短的时间内完成比以前更多的工作，而不会增加成本。

 DESCRIPTION (provided by applicant): We seek to continue our population-based study of stroke incidence and case fatality, prevalence of risk factors, stroke treatment, and post-stroke outcomes within a biracial metropolitan population of 1,368,604 of whom 223,417 (16.3%) are of black race (US Census 2010). The proposed work will involve an anticipated ~3,750 patients with 4,250 strokes and/or transient ischemic attacks from our region in 2014/2015, an estimated ~600 recurrent strokes from 2015-2018 (following all strokes and transient ischemic attacks for 3 years after the original 2014/2015 event), as well as 2,000 survey participants. For almost 20 years, we have studied trends in stroke incidence and case fatality and have demonstrated a racial disparity where stroke incidence in African-Americans is more than double that of whites. In each prior study period, we have also examined the prevalence of risk factors (and knowledge of stroke) via a population survey in order to put our temporal trend findings into context. In addition to continuing these important activities, we seek to examine stroke recurrence in a population- based fashion (which has not been done since the 1990's) with the goal of identifying whether there is a racial disparity in stroke recurrence. We propose an innovative pilot study to determine if we can estimate functional outcome and place of residence at 3- and 6-months post-stroke without patient contact, using a local health- information exchange (HIE) and electronic health record. We will compare our estimate to phone interviews with the subject as the "gold standard"; the phone interview to be used was successfully piloted in the current period. Finally, we have used our data to inform eligibility for stroke clinical trils. We propose to share our data with the scientific community for this purpose. In our proposed work, we will have data regarding acute stroke presentation and will add information about stroke recurrence and post-stroke functional outcomes that can be used for rational planning of stroke interventions in all phases of stroke (acute, secondary prevention, recovery). In all of th proposed activities, the use of the HIE will make the proposed work possible (harnessing the power of centralized health data) and will be important for accomplishing the work efficiently. Overall, our proposed study will accomplish more than prior periods in a shorter time and without increased cost.