Racial Disparities in Ischemic Stroke &Atherosclerotic Risk Factors In the Young

传统上，儿童和年轻人中风与多种病因有关，如创伤， 先天性心脏病、自身免疫性疾病和血液病，而动脉粥样硬化的危险因素 被认为不重要。然而，尸检和颈动脉超声研究表明，动脉粥样硬化 从童年开始，最近的流行病学研究表明，动脉粥样硬化的危险因素是 在青少年和年轻的中风患者中日益流行。黑人种族赋予了类似的 儿童和成人的中风风险都会增加，黑人儿童的额外风险似乎不会 完全可以用镰状细胞病来解释。我们假设年轻人的中风发病率比 在过去的20年里，种族和动脉粥样硬化的危险因素在这一增长中发挥了作用。具体的 目标是： 目的1：开发一种使用电子数据识别缺血的高度敏感和特异的算法 中风和动脉粥样硬化的危险因素(高血压、高脂血症、糖尿病、肥胖、吸烟) 在KPNC的儿童和成人队列中，并在KPNC内的单独队列中验证该算法。 目标2：在KPNC内以人口为基础的大型儿童和年轻人(50岁)队列中，15- 年份时间段： A.确定缺血性中风发病率的总体趋势，并评估这一趋势 在种族和性别亚组中的中风发病率。 B.在因中风住院的子队列成员中，确定 动脉粥样硬化危险因素的流行情况，并评估这些危险因素的流行趋势 在种族和性别的亚群中。 目的3：在KNPC儿童和年轻人队列中嵌套的病例对照研究中，评估 社会经济地位、动脉粥样硬化危险因素、创伤、镰状细胞病和其他中风的作用 危险因素，在种族差异中卒中发病率。

Traditionally, stroke in children and young adults has been linked to diverse etiologies such as trauma, congenital heart disease, and autoimmune and hematologic diseases, while atherosclerotic risk factors have been considered unimportant. However, autopsy and carotid ultrasound studies suggest that atherosclerosis begins in childhood, and recent epidemiological studies suggest that atherosclerotic risk factors are increasingly prevalent among adolescents and young adults with stroke. Black race confers a similariy increased stroke risk in both children and adults, and the excess risk in black children does not appear to be fully explained by sickle cell disease. We hypothesize that stroke rates in the young have increased over the last 2 decades, and that race and atherosclerotic risk factors play a role in this increase. The specific aims are: Aim 1: To develop a highly sensitive and specific algorithm for using electronic data to identify ischemic stroke and atherosclerotic risk factors (hypertension, hyperiipidemia, diabetes mellitus, obesity, smoking) in a cohort of children and adults in KPNC, and to validate this algorithm in a separate cohort within KPNC. Aim 2: In a large population-based cohort of children and young adults (<age 50) within KPNC over a 15- year time period: a. To determine the overall trend in the incidence rate of ischemic stroke, and to evaluate the trend in stroke incidence rates among subgroups of race and gender. b. Among a sub-cohort of members hospitalized for stroke, to determine the overall trends in the prevalence of atherosclerotic risk factors, and to evaluate the trends in prevalence of these risk factors among subgroups of race and gender. Aim 3: In a case-control study nested within the cohort of children and young adults in KNPC, to evaluate the role of socioeconomic status, atherosclerotic risk factors, trauma, sickle cell disease, and other stroke risk factors, in the ethnic disparities of stroke incidence.