Examining Racial Disparities in Stroke

描述（由申请人提供）：中风是美国人死亡的第四大原因，在非洲裔美国人中排名第三，非洲裔美国人的风险是白人的两倍多。中风中种族差异的根本原因尚不清楚。很少有研究系统地评估脑卒中的种族差异是如何因社会经济和行为风险因素（如社会经济地位[SES]、肥胖、体育活动和酒精）而变化的，它们可能通过在种族和脑卒中之间因果通路中的中介作用来解释观察到的差异。关于社会经济和行为风险因素对脑卒中风险预测的影响的研究一直很缺乏。此外，迫切需要验证现有的非裔美国人脑卒中预测评分。这一创新项目将通过以下方式解决文献中的这些空白：(1)确定脑卒中的种族差异和选择的脑卒中危险因素与种族的关联是否在两个双种族社会经济异质性人群中具有可比性；(2)使用传统和因果框架确定社会经济和行为脑卒中危险因素的中介是否在传统脑卒中危险因素之外解释脑卒中的种族差异。(3)与现有的脑卒中预测模型相比，研究种族特异性脑卒中预测模型是否提高了长期脑卒中风险的预测性能（校准和区分）。这些目标将通过使用三个多种族、完善的美国国立卫生研究院资助的队列来实现；妇女健康倡议，南方社区队列研究（SCCS）和中风的地理和种族差异的原因。将采用综合办法审查种族差异。新的因果中介分析将补充传统的流行病学方法，并推动该领域向前发展。此外，种族特异性脑卒中预测模型将有助于在高危人群中制定更好的预防策略。这些社会经济和行为中风危险因素通常在诊所常规收集或可以以最低的成本获得。这项资助将通过培养我在以下方面的专业知识，为我成为心血管疾病（CVD）种族/民族差异领域的独立流行病学家提供新的知识和重要的培训：(1)CVD的种族差异和社会决定因素；(2)中介分析统计培训；(3)预测建模方法训练；(4)使用医疗保险索赔数据（CMS）进行数据管理和分析技能，以确定SCCS中的卒中；(5)试点医疗记录收集，以验证SCCS中的卒中。该职业发展奖提供的高级培训、指导和保护时间将为开展最高质量的种族/民族心血管差异研究提供必要的技能和经验，并为作为独立的流行病学种族/差异调查员的成功奠定坚实的基础。

DESCRIPTION (provided by applicant): Stroke is the 4th leading cause of US mortality and 3rd among African Americans, with African Americans exhibiting more than twice the risk of Whites. The underlying causes of racial disparities in stroke are unclear. Few studies have systematically evaluated how racial disparities in stroke might vary by socioeconomic and behavior risk factors (e.g. measures of socioeconomic status [SES], adiposity, physical activity and alcohol) and they might explain the observed disparities through their roles as intermediates in the causal pathway between race and stroke. There has been a paucity of research on the impact of socioeconomic and behavioral risk factors in stroke risk prediction. Moreover, validation of existing stroke prediction scores among African Americans is urgently needed. This innovative project will address these gaps in the literature by: (1) determining whether racial disparities in stroke and the associations of selected stroke risk factors by race are comparable in two biracial socioeconomically heterogeneous populations, (2) determining whether mediation by socioeconomic and behavioral stroke risk factors account for racial disparities in stroke beyond traditional stroke risk factors using conventional and causal frameworks, and (3) examining whether race-specific stroke prediction models improve the predictive performance (calibration and discrimination) of long-term stroke risk compared to existing stroke prediction models. These aims will be accomplished through the use of three multi-racial, well-established NIH-funded cohorts; the Women's Health Initiative, Southern Community Cohort Study (SCCS) and Reasons for Geographic and Racial Differences in Stroke. A comprehensive approach to examining racial disparities will be utilized. Novel causal mediation analyses will complement conventional epidemiologic methods and move the field forward. Furthermore, race-specific stroke prediction models will enable the development of improved prevention strategies among at-risk individuals. These socioeconomic and behavioral stroke risk factors are often routinely collected in the clinic or could be obtained at minimal cost. This grant will generate new knowledge and crucial training for my advancement to become an independent epidemiologist in the field of racial/ethnic disparities in cardiovascular disease (CVD) by developing my expertise in (1) racial disparities and social determinant of CVD; (2) statistical training in mediation analyses; (3) methodologic training in prediction modeling; (4) data management and analytic skills with Medicare claims data (CMS) for stroke ascertainment in SCCS and (5) pilot medical record collection for stroke validation in SCCS. The advanced training, mentorship and protected time provided by this career development award will provide the skills and experience necessary for conducting the highest quality racial/ethnic cardiovascular disparities research and a strong foundation for success as an independent epidemiologic racial/disparities investigator.