Etiology of Geographic and Racial Differences in Stroke

“中风带”是美国东南部的一个中风多发地区， 死亡率约25%以上的其他国家，并包含一个 中风死亡率甚至更高的地区（“中风扣”）。此外，非洲 美国人的中风死亡率比白人高50%。有很多 关于这些地理和种族死亡率过高的假设，但 几乎没有数据来评估原因。该提案将解决缺乏 信息在多个层面。地理和种族差异的作用 发病率和死亡率作为造成不同死亡率的因素， 接受检查。广泛流行的地理和种族差异 一系列的风险因素，以及地理和种族差异， 对这些因素的敏感性，将被估计。移徙的影响 将对各地区进行评估。最后，候选基因的作用 将对卒中的地理和种族差异进行评估。 这项研究将在全国范围内招募30，000名无中风参与者 55岁以上的人三分之一（1/3）的参与者将来自中风 带，1/3从中风扣，1/3从美国其他地区。内 1/2的参与者将是非洲裔美国人，1/2的白色和1/2的 男性和1/2女性。将确定参与者的风险因素状况 通过电话访谈、入户访问和GIS数据。则将队列 前瞻性随访3年，以了解卒中事件。这 前瞻性队列设计提供了许多优势，包括直接 评估发病率和病死率，并允许评估 在卒中事件之前评估的风险因素的作用。本研究 讨论了中风死亡率过高的各种假设原因 在美国东南部和非洲裔美国人中， 设计干预措施以降低过度卒中死亡率的信息 这些人口。

The "Stroke Belt" is an area in the Southeastern US with stroke mortality rates approximately 25% above the rest of the nation, and contains a region of even higher stroke mortality (the "Stroke Buckle"). Also, African American stroke mortality is 50% higher than in whites. There are many hypotheses concerning these geographic and racial excesses in mortality, but little data to assess the causes. This proposal will address the lack of information at many levels. The role of geographic and racial differences in incidence and casefatality as contributors to differential mortality rates will be examined. Geographic and racial differences in the prevalence of a wide range of risk factors, and geographic and racial differences in the susceptibility to these factors, will be estimated. The impact of migration between regions will be evaluated. Finally, the role of candidate genes for stroke on the geographic and racial differences in stroke will be assessed. This study will recruit a nationwide cohort of 30,000 stroke-free participants over the age of 55. One-third (1/3) of the participants will be from the Stroke Belt, 1/3 from the Stroke Buckle, and 1/3 from the rest of the US. Within regions, 1/2 of the participants will be African American and 1/2 white and 1/2 male and 1/2 female. The risk factor status of participants will be established by a telephone interview, an inhome visit, and from GIS data. The cohort will be prospectively followed for 3 years for incident stroke events. This prospective cohort design offers many advantages including the direct assessment of incidence and case-fatality, and permitting the assessment of the role of risk factors that were evaluated prior to the stroke event. This study addresses the wide range of hypothesized causes of the excess stroke mortality in the Southeastern US and among African Americans, and will provide information to design interventions to reduce the excess stroke mortality in these populations.