Stroke has the largest racial disparity of any chronic disease, Geographic disparities also exist, and the magnitude of both disparities is increasing. Alarmingly, REGARDS has documented racial and geographic disparities in cognitive decline that are of the same magnitude as for stroke. A lack of understanding of the causes of these disparities has contributed directly to the failure to reduce or eliminate them. REGARDS is a national cohort of 30,239 black and white community-dwelling participants aged 45+ when enrolled in 2003-2007. We propose to utilize the cohort to build on findings to date and extend our findings to evaluate new hypotheses. REGARDS is positioned to document disparities in incidence of stroke and cognitive impairment and also to understand why these disparities exist. We propose to conduct a second in-person evaluation to define incidence and progression of stroke risk factors. We will continue stroke ascertainment to double the number of stroke events and improve our ability to define factors contributing to the as yet """"""""unexplained"""""""" stroke disparities. By continuing cognitive assessments, and adding more sensitive in-person measures of cognitive function, and instrumental activities of daily living, we will advance the understanding of causes and clinical relevance of disparities in cognitive decline. We propose the following specific aims: ? Specific Aim #1: to quantify incidence of, and change in severity of stroke risk factors over 9 years of follow-up, and to establish causes for racial and geographic disparities in these risk factors. ? Specific Aim #2: to evaluate three pathways that may account for """"""""unexplained"""""""" disparities: a) differential impact of risk factors where the same change in risk factor increases risk more for one race than the other, b) residual confounding from incomplete characterization of risk factors, and c) """"""""novel"""""""" stroke risk factors including psychosocial and behavioral factors. ? Specific Aim #3: Measure the functional impact of cognitive impairment, estimate the prevalence and incidence of cognitive impairment over 10 years of follow-up, and account for racial disparities in cognition attributable to literacy by gathering new information on functional performance and word reading ability.

Public Health Relevance

Estimates suggest that the racial and geographic disparities in stroke are associated with over 20,000 extra stroke events annually, with an estimated cost per stroke of $140,000;hence, the public health burden of these disparities is in excess of $6 billion dollars annually. If this research provides insights that would contribute to a 10% reduction in the magnitude of these disparities, the entire 5-year cost of this application would be recouped in savings in less than 16 days (a savings that would reoccur each 16 days). Our previous work in REGARDS has documented similar racial and geographic disparities in cognitive function, and these disparities in cognitive function will have similar public health ramifications with the graying of America.

National Institute of Health (NIH)
National Institute of Neurological Disorders and Stroke (NINDS)
Research Project--Cooperative Agreements (U01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-PSE-P (02))
Program Officer
Odenkirchen, Joanne
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Alabama Birmingham
Biostatistics & Other Math Sci
Schools of Public Health
United States
Zip Code
Rembert, Nicole; He, Ka; Judd, Suzanne E et al. (2017) The geographic distribution of trace elements in the environment: the REGARDS study. Environ Monit Assess 189:84
Mallick, Himel; Yi, Nengjun (2017) Bayesian Group Bridge for Bi-level Variable Selection. Comput Stat Data Anal 110:115-133
Akinyemiju, Tomi; Moore, Justin Xavier; Judd, Suzanne et al. (2017) Metabolic dysregulation and cancer mortality in a national cohort of blacks and whites. BMC Cancer 17:856
Merrill, Peter D; Ampah, Steve B; He, Ka et al. (2017) Association between trace elements in the environment and stroke risk: The reasons for geographic and racial differences in stroke (REGARDS) study. J Trace Elem Med Biol 42:45-49
Naik, Rakhi P; Irvin, Marguerite R; Judd, Suzanne et al. (2017) Sickle Cell Trait and the Risk of ESRD in Blacks. J Am Soc Nephrol 28:2180-2187
Howard, George; Kleindorfer, Dawn O; Cushman, Mary et al. (2017) Contributors to the Excess Stroke Mortality in Rural Areas in the United States. Stroke 48:1773-1778
MacDonald, Leslie A; Bertke, Stephen; Hein, Misty J et al. (2017) Prevalence of Cardiovascular Health by Occupation: A Cross-Sectional Analysis Among U.S. Workers Aged ?45 Years. Am J Prev Med 53:152-161
Landry, K K; Alexander, K S; Zakai, N A et al. (2017) Association of stroke risk biomarkers with stroke symptoms: the Reasons for Geographic and Racial Differences in Stroke cohort. J Thromb Haemost 15:21-27
Loop, Matthew Shane; Howard, George; de Los Campos, Gustavo et al. (2017) Heat Maps of Hypertension, Diabetes Mellitus, and Smoking in the Continental United States. Circ Cardiovasc Qual Outcomes 10:
Zhu, Wenfei; Wadley, Virginia G; Howard, Virginia J et al. (2017) Objectively Measured Physical Activity and Cognitive Function in Older Adults. Med Sci Sports Exerc 49:47-53

Showing the most recent 10 out of 359 publications