Comparison of Hemorrhagic & Ischemic Stroke Among Blacks and Whites

描述(由申请人提供)：我们寻求继续我们的基于人群的研究，在我们的混血大都市人口1,349,351人中，其中215,611人(15%)是黑人，研究中风的发病率、危险因素、治疗和结果(美国人口普查2000)。近15年来，我们研究了中风发病率和病死率的趋势，以及危险因素的流行率和中风的知识(通过人口调查)，并证明了非洲裔美国人中风发病率是白人的两倍以上的种族差异。除了继续这些重要的活动外，我们还提出了一项创新的先导性研究，这将是迄今为止最大的前瞻性、基于人群的卒中结果研究。预计2010年我区约3200例中风患者和800例TIA，以及2000名接受调查的参与者将被用来检验以下假设：1.中风发病率的时间趋势将显示白人随着时间的推移而下降(如我们2005年的初步数据所示)。然而，黑人不会出现类似的下降，这是一个在其他中风时间研究中没有被研究过的种族群体。我们预计，病死率不会在不同时期发生变化，黑人和白人的死亡率将是相似的。2.与同意接受面对面访谈的受试者相比，区域HIE结合电话随访的受试者队列更能代表本地区的整个卒中人群，后者可能存在参与和生存偏见。通过这种方法获得的信息将与从手动图表提取和直接访谈中获得的数据一样有效，以确定一个地区中风后获得护理的机会和单个患者的功能结果，并且收集起来将比通过手动过程获得的信息更有效。3.根据我们的初步数据，在2006至2011年间，知道中风警告迹象或危险因素的人口比例不会有所改善。当受试者被问及他们自己中风的个人风险时，自我感知的风险越低，中风知识就越差。公共卫生相关性：中风发病率随时间的变化是对科学将新发现转化为人群利益的最终考验。我们的研究考察了过去15年中中风的种族差异，结果表明黑人中风的风险比白人高。在我们的人群中，中风在白人中的发生率正在下降，但在非裔美国人中没有，我们将继续描述在混血大都市人口中中风的发生、原因、治疗和结果的趋势。

DESCRIPTION (provided by applicant): We seek to continue our population-based study of stroke incidence, risk factors, treatment, and outcome of stroke within our biracial metropolitan population of 1,349,351, of whom 215,611 (15%) are of black race (US Census 2000). We have studied trends in stroke incidence and case fatality, as well as the prevalence of risk factors and knowledge of stroke (via a population survey) for almost 15 years and have demonstrated a racial disparity where stroke incidence in African-Americans is more than double that of whites. In addition to continuing these important activities, we propose an innovative pilot study that will be the largest prospective, population-based stroke outcomes study to date. The anticipated ~3,200 patients with strokes and 800 TIAs from our region in 2010, as well as the 2,000 surveyed participants, will be used to test the following hypotheses: 1. Temporal trends in the incidence rate of stroke will demonstrate a decrease over time in whites (as shown by our 2005 preliminary data). However, there will not be a similar decrease among blacks, a racial group that has not been examined in other temporal studies of stroke. We expect that case fatality rates will not change between periods, and will be similar for both blacks and whites. 2. A cohort of subjects followed by a regional HIE combined with phone-call follow-up will be more representative of the entire stroke population in our region than a cohort of subjects that agree to in-person interviews, which is likely to have participation and survival biases. Information obtained via this approach will be as valid as data from manual chart abstraction and direct interview for determining access to care and individual patients' functional outcome after stroke across a region, and will be more efficient to collect than that obtained via manual processes. 3. The proportion of the population that knows warning signs or risk factors for stroke will NOT improve between 2006 and 2011, based on our preliminary data. When subjects are asked about their own personal risk for stroke, a lower self-perceived risk will be associated with worse stroke knowledge. PUBLIC HEALTH RELEVANCE: The change in stroke occurrence over time is the ultimate test of how well science has translated new discoveries into benefits for the population. Our study has examined racial disparities in stroke over the last 15 years, showing that blacks have higher risk for stroke than whites. In our population, the occurrence of stroke is decreasing in whites but not African Americans, and we will continue to describe trends in stroke occurrence, cause, treatment, and outcome in a biracial metropolitan population.