Disparities in Patterns of Recurrent Stroke in the Elderly

中风是美国的一个主要公共卫生问题。它是第五大死亡原因， 导致成年人严重残疾的主要原因。据估计，在美国， 年，估计有7百万中风幸存者。20%的中风幸存者需要机构护理 3个月后，15%-30%的人永久残疾。复发事件，发生在185，000例卒中中 在美国每年的幸存者，与更高的死亡率，更高的残疾水平， 并且与第一冲程相比增加了成本。成年人的中风具有很强的年龄依赖性， 与中风相关的不良结局和并发症随着年龄的增长而增加。因为联合 美国人口正在老龄化，未来中风和复发事件的风险人群将增加 几十年中风及其相关缺陷的高患病率给患者带来了巨大的负担， 家庭和医疗系统。优化卒中的急性期后护理和二级预防工作 幸存者是减少复发性卒中负担的重要目标，特别是在 老人已经确定了卒中发病率、患病率和死亡率的种族/民族和地区差异， 死亡率，但相对较少的研究集中在复发性卒中模式的潜在差异 事件老年人复发性卒中模式的差异研究将使用医疗保险管理 数据，以实现以下具体目标：1）评估国家卒中复发率的时间模式 在因缺血性中风住院的老年医疗保险受益人中， 社会人口统计学和共病/临床特征;和2）确定县级复发率 中风，地理模式随时间的持续性，以及可能导致中风的县一级因素， 差距。临床实践、公共政策和报销决策越来越多地由数据提供信息 从行政数据库中获取。老年人复发性卒中模式的差异研究将 是当代美国最大的中风复发率和模式的调查。结果 从这个项目将确定地理区域和亚组，有独特的健康档案，把他们 中风复发的风险很高这些信息将告知护理提供者、保险公司、公共卫生机构， 和政策制定者关于社区，可能会获得最大的利益，从有针对性的计划， 基于社区的干预。

Stroke is a major public health problem in the United States. It is the fifth leading cause of death and a leading cause of serious disability in adults. There are an estimated 800,000 strokes in the United States each year, with an estimated 7 million stroke survivors. Twenty percent of stroke survivors require institutional care after 3 months and 15%-30% are permanently disabled. Recurrent events, which occur in 185,000 stroke survivors in the United States each year, are associated with higher mortality rates, greater levels of disability, and increased costs as compared with first strokes. Stroke in adults is strongly age dependent, and the rate of adverse outcomes and complications associated with stroke increases with advanced age. Because the United States population is aging, the population at risk for stroke and recurrent events will increase over the coming decades. The high prevalence of stroke and its associated deficits impose a large burden on patients, their families, and the healthcare system. Optimizing post-acute care and secondary prevention efforts for stroke survivors represents an important target to reduce the burden of recurrent stroke, particularly among the elderly. Racial/ethnic and regional disparities have been identified for stroke incidence, prevalence, and mortality, but relatively little research has focused on potential disparities in the patterns of recurrent stroke events. The Disparities in Patterns of Recurrent Stroke in the Elderly study will use Medicare administrative data to achieve the following specific aims: 1) to assess temporal patterns in national recurrent stroke rates among elderly Medicare beneficiaries hospitalized with ischemic stroke and describe disparities by sociodemographic and comorbid/clinical characteristics; and 2) to determine county-level rates of recurrent stroke, the persistence of geographic patterns over time, and county-level factors that may be contributing to disparities. Clinical practice, public policy, and reimbursement decisions are increasingly informed by data obtained from administrative datasets. The Disparities in Patterns of Recurrent Stroke in the Elderly study will be the largest contemporary investigation of recurrent stroke rates and patterns in the United States. Results from this project will identify geographic areas and subgroups that have distinctive health profiles that put them at high risk for recurrent stroke. Such information will inform care providers, insurers, public health agencies, and policy makers about communities that may derive the greatest benefit from targeted programs and community-based interventions.