Disparities in Patterns of Recurrent Stroke in the Elderly

项目摘要/摘要 在美国，中风是一个主要的公共卫生问题。它是第五大死因，也是第一大死因 成年人严重残疾的原因。据估计，美国每年有80万人中风， 有超过760万中风幸存者。20%的中风幸存者在3岁后需要机构护理 15%-30%的人是永久残疾的。成年人中的中风与年龄密切相关，而中风的发生率 与中风相关的不良后果和并发症随着年龄的增加而增加。因为美联队 各州人口正在老龄化，人口面临中风、反复中风事件和其他中风后的风险 在未来的几十年里，结果将会增加。它的高流行率、相关的缺陷和不利的 结果给患者、他们的家人和医疗保健系统带来了巨大的负担。中风幸存者在 由于他们的功能残疾、神经缺陷和先前存在的心血管疾病而导致新疾病的高风险 风险因素和共病。建议的续订申请建立在原始R01的基础上( 老年复发性卒中的模式研究)来扩展我们广泛的与患者相关的监测数据库 提供有关缺血性卒中后1、5和10年预后的模式和趋势的宝贵信息。 我们将结合2017年至2024年的Medicare按服务收费和Medicare Advantage管理数据，以 实现以下具体目标：1)在一年内评估国家和县一级的比率和趋势 联邦医疗保险优势和服务收费受益者对缺血性中风的转归和描述 2017年至2024年社会人口因素的差异；2)评估医疗保险的5年成果 缺血性卒中的优势和服务费用受益者，并按社会人口统计学描述差异 2017-2024年的因素、临床特征和地理位置；3)评估5年和10年- 对患有缺血性中风的医疗保险按服务付费受益人的年度结果进行描述，并按 2001-2024年社会人口学因素和地区。临床实践、公共政策和报销 从行政数据集获得的数据越来越多地为决策提供信息。拟议的研究将是 当代最大的卒中复发率、卒中后事件和长期随访研究 在美国，医疗保险受益人因缺血性中风住院。这个项目的结果将是 确定具有独特健康状况的地理区域和亚组，这些地区和亚组的健康状况使他们处于患高血压的高危状态 中风后的不良后果。这些信息将通知护理提供者、保险公司、公共卫生机构、 和政策制定者关于可能从有针对性的计划中获得最大好处的社区和 以社区为基础的干预。

Project Summary/Abstract 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 more than 7.6 million stroke survivors. Twenty percent of stroke survivors require institutional care after 3 months and 15%-30% are permanently disabled. 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, recurrent stroke events, and other post-stroke outcomes will increase over the coming decades. Its high prevalence, associated deficits, and adverse outcomes impose a large burden on patients, their families, and the healthcare system. Stroke survivors are at high risk of new diseases due to their functional disability, neurological deficits, and pre-existing cardiovascular risk factors and comorbidities. The proposed renewal application builds on the Original R01 (Disparities in Patterns of Recurrent Stroke in the Elderly study) to expand our extensive patient-linked surveillance database to provide invaluable information on patterns and trends of 1-, 5-, and 10-year outcomes after ischemic stroke. We will combine Medicare fee-for-service and Medicare Advantage administrative data for 2017 to 2024 to accomplish the following specific aims: 1) to assess national and county-level rates and trends in 1-year outcomes for Medicare Advantage and fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors from 2017 to 2024; 2) to assess 5-year outcomes for Medicare Advantage and fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors, clinical characteristics, and geographic location from 2017 to 2024; and 3) to assess 5-year and 10- year outcomes for Medicare fee-for-service beneficiaries with ischemic stroke and describe disparities by sociodemographic factors and region from 2001 to 2024. Clinical practice, public policy, and reimbursement decisions are increasingly informed by data obtained from administrative datasets. The proposed study will be the largest contemporary investigation of recurrent stroke rates, post-stroke events, and long-term follow-up of Medicare beneficiaries hospitalized with ischemic stroke 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 adverse outcomes after 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.