Built environments on stroke risk and stroke disparities in a national sample

 描述（由申请人提供）：中风是死亡的主要原因之一，也是严重长期残疾的首要原因。在个体水平上已经建立了许多中风风险因素;然而，这些风险因素只能部分解释中风风险， 中风的种族差异只有一半。必须识别新的卒中风险暴露，以提高我们对卒中风险的理解，并制定有效的干预措施。最近，建筑和社会环境（BSE）已被确定为重要因素，以进一步了解心血管疾病。然而，到目前为止，还没有研究检查BSE对中风风险的影响。BSE也可能有助于解释中风发生率的巨大种族和地理差异，尽管这还有待于在全国范围内进行实证研究。拟议的研究将通过使用一个独特的组合队列（即卒中地理和种族差异的原因（REGARDS）队列）来解决这些差距。REGARDS队列是45岁以上成年人的全国样本，其中有非洲裔美国人参与者和中风带的人。该研究将扩展REGARDS研究，以检查BSE对卒中风险以及卒中种族和地理差异的影响。这些目标将通过获得关于REGARDS参与者建筑环境的广泛BSE特征的数据来实现（例如，食物可用性、公园可用性、食物价格、体育活动设施可用性、土地使用、街道连通性和邻里物理环境）和参与者的社会环境（客观犯罪、感知犯罪、邻里SES、社会凝聚力、种族居住隔离、社会支持和社交网络以及邻里社会环境）。这些数据将从多个来源获得，包括二级商业和行政来源、参与者自我报告和使用谷歌地球街景功能进行的初步审计。环境数据将在空间上与REGARDS病例队列研究的参与者数据相关联。拟议的研究旨在：1）在REGARDS研究中检查BSE对卒中事件风险的贡献程度; 2）确定BSE在多大程度上解释卒中事件中的种族和地理差异。拟议的研究以重要的初步研究和调查小组的广泛相关经验为基础，调查小组包括若干机构的著名学者。拟议的研究提供了一种具有成本效益的方法来检查不同社区环境和种族群体中BSE对中风预防的重要性。确定可预测中风事件的疯牛病特征以及导致种族和地理差异的疯牛病特征将有助于为未来的环境改造提供信息，以改善人群健康。在研究期结束时，BSE数据将通过REGARDS数据共享方案提供给其他人;因此，拟议研究中的措施将提供给更大的科学界，用于与其他疾病结局相关的研究。

 DESCRIPTION (provided by applicant): Stroke is one of the leading causes of death and a top cause of serious long-term disability. A number of stroke risk factors have been established at the individual-level; however, these risk factors only partially explain stroke risk and account for only half of the racial disparities in stroke. Novel exposures of stroke risk must be identifie to improve our understanding of stroke risk and to develop effective interventions. Recently, built and social environments (BSEs) have been identified as important factors to examine to further our understanding of cardiovascular disease. However, to date no studies have examined the effect of BSEs on stroke risk. BSEs may also help to explain the large racial and geographic disparities in stroke rates although this has yet to be empirically examined nationally. The proposed study would address these gaps by utilizing a unique assembled cohort, namely the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The REGARDS cohort is a national sample of adults over age 45, with oversamples of African-American participants and persons in the stroke belt. The proposed study will expand the REGARDS study to examine the effects of BSEs on incident stroke risk and on racial and geographic disparities in stroke. These aims will be achieved by obtaining data on a broad range of BSE characteristics of the REGARDS participants' built environment (e.g., food availability, park availability, food prices, physical activity facility availability, land use, steet connectivity and neighborhood physical environment) and participants' social environment (objective crime, perceived crime, neighborhood SES, social cohesion, racial residential segregation, social support and social networks, and neighborhood social environment). The data will be obtained from a number of sources including secondary commercial and administrative sources, participant self-reports and primary audits using the Street View feature in Google Earth. Environmental data will be spatially linked to participant data of the REGARDS case-cohort study. The proposed study aims to 1) examine the extent to which BSEs contribute to incident stroke risk in the REGARDS study; and 2) determine the extent to which BSEs explain racial and geographic disparities in incident stroke. The proposed study builds on important preliminary studies and the extensive relevant experience of the investigative team, which includes prominent scholars across a number of institutions. The proposed research provides a cost-effective way to examine the importance of BSEs for stroke prevention across diverse community settings and racial groups. Identifying the BSE characteristics that are predictive of incident stroke and BSEs that contribute to racial and geographic disparities will help inform future modifications of environments to improve population health. At the end of the study period, the BSE data will be made available to others through the REGARDS data sharing protocols; thus the measures in the proposed study will be available to the greater scientific community for use in research pertaining to other disease outcomes.