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， 超过440万中风幸存者。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 几十年它的高患病率和相关的缺陷给患者、他们的家庭和他们的家人带来了巨大的负担。 医疗保健系统。优化中风幸存者的急性期后护理和二级预防工作 是减少复发性卒中负担的一个重要目标，特别是在老年人中。种族- 在中风的发病率、患病率和死亡率方面存在种族和地区差异， 很少有研究关注复发性中风事件模式的潜在差异。的模式 老年人复发性卒中研究将使用医疗保险管理数据来实现以下具体目标 目的：1）确定因缺血性脑卒中住院的老年医疗保险受益人的卒中复发率， 中风和评估地理和社会人口学特征的复发率差异;和2） 确定可能影响治疗效果的社会经济学、医疗服务可及性、生活方式/合并症和急性期后护理因素， 有助于复发性卒中事件的变化。临床实践、公共政策和报销决策 越来越多地从行政数据集获得的数据中获得信息。脑卒中复发的类型 老年人研究将是当代最大的中风复发率和模式的调查， 美国的该项目的结果将确定具有独特优势的地理区域和亚组， 健康状况使他们处于中风复发的高风险之中。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对可能获得最大利益的社区进行评估 从有针对性的项目和社区干预中。

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 4.4 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. Its high prevalence and 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 morality, but relatively little research has focused on potential disparities in the patterns of recurrent stroke events. The Patterns of Recurrent Stroke in the Elderly Study will use Medicare administrative data to achieve the following specific aims: 1) to determine rates of recurrent stroke in elderly Medicare beneficiaries hospitalized with ischemic stroke and assess disparities in recurrent rates by geographic and sociodemographic characteristics; and 2) to identify socioeconomic, healthcare access, lifestyle/comorbidity, and post-acute care factors that may contribute to variation in recurrent stroke events. Clinical practice, public policy, and reimbursement decisions are increasingly informed by data obtained from administrative datasets. The 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.