Stroke is common, nearly 800,000 strokes occur annually, and a leading cause of disability in the U.S. Non-Hispanic Black/African American (Black) adults have the highest stroke prevalence and suffer the most post-stroke disability of any U.S. racial/ethnic group. Even though racial disparities in post-stroke disability are widespread, little it is known about how to reduce this disparity. Racial differences in disability arise in the post-stroke period;however it is unclear if these differences arise shortly after strke in the early recovery period, when many stroke survivors are undergoing rehabilitation, or after stroke survivors return to the community. This project will address the critical questions of when racial disparities in post-stroke disability arise and determine the drivers of this disparity in ech period. Answering these questions is an essential step to designing interventions to improve health in Black stroke survivors and reduce disparities. To address these questions, we will rely on the newly available National Health and Aging Trends Study (NHATS) linked to Medicare claims and functional assessment data. NHATS is a national, longitudinal survey of Medicare beneficiaries focused on understanding the causes and consequences of disability in the elderly. NHATS performs annual face-to-face interviews to carefully characterize disability in the elderly and measures a vast array of disability predictors including social, community and disability accommodation factors. Additionally NHATS's linkage to Medicare claims will enable measurement of important medical and rehabilitation factors that may also explain racial differences in post-stroke disability. These data sources will be used to develop the first comprehensive measures of rehabilitation intensity across all rehabilitation settings-home health, outpatient, skilled nursing and inpatient rehabilitation-compare intensity by race and estimate the effect of rehabilitation intensity on disability disparities. At the completion of the study, the timing and drivers of race differences in post-stroke disability will be identified. Furthermore, our novel measures of rehabilitation intensity can serve as a prototype for use in studying the role of rehabilitation in other diseases such as traumatic brain injury and arthritis. This proposal is particularly responsive to the NIMHD solicitation in that it focuses on modifiable drivers of racial differences in post-stroke disability from a policy standpoint and will directly inform stroke survivor and family level strategies to reduce disability and decrease disparities.

Public Health Relevance

Non-Hispanic Black/African American (Black) adults have more strokes and experience greater disability after their strokes than non-Hispanic White adults. Using newly available data, this project will determine the time when racial differences in post-stroke disability arise and the factors that lead to racial differences in post- stroke disabiity. These results will be directly used to develop strategies and interventions to improve the health of Black stroke survivors and reduce disparities.

National Institute of Health (NIH)
Research Project (R01)
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Application #
Study Section
Special Emphasis Panel (ZMD1)
Program Officer
Alvidrez, Jennifer L
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University of Michigan Ann Arbor
Schools of Medicine
Ann Arbor
United States
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Callaghan, Brian C; Burke, James F; Feldman, Eva L (2016) Electrodiagnostic Tests in Polyneuropathy and Radiculopathy. JAMA 315:297-8
Levine, Deborah A; Burke, James F (2016) Stroke Imaging: Quantity, But is There Quality? Med Care 54:423-5
Skolarus, Lesli E; Freedman, Vicki A; Feng, Chunyang et al. (2016) Care Received by Elderly US Stroke Survivors May Be Underestimated. Stroke 47:2090-5
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Callaghan, Brian; Kerber, Kevin; Langa, Kenneth M et al. (2015) Longitudinal patient-oriented outcomes in neuropathy: Importance of early detection and falls. Neurology 85:71-9
De Lott, Lindsey B; Burke, James F; Michigan Neuro-Ophthalmology Research Consortium (2015) Use of laboratory markers in deciding whether to perform temporal artery biopsy. JAMA Ophthalmol 133:605-6
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Skolarus, Lesli E; Burke, James F (2015) Towards an Understanding of Racial Differences in Post-stroke Disability. Curr Epidemiol Rep 2:191-196
Burke, James F; Skolarus, Lesli E; Freedman, Vicki A (2015) Racial Disparities in Poststroke Activity Limitations Are Not due to Differences in Prestroke Activity Limitation. J Stroke Cerebrovasc Dis 24:1636-9

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