Mortality data suggest a higher risk of stroke among blacks, but there is little data contrasting stroke incidence, risk and prognosis in blacks, Hispanics and whites in the same population using similar methods. This proposal will provide vital information to help develop targeted stroke prevention strategies in population subgroups which can be used to achieve Health Objective 15.2 of Healthy People 2000 to reduce stroke deaths. This revised prospective, hospital and community based, 5-year study is designed to determine the incidence of symptomatic stroke, the effect of stroke risk factors and the 1-4 year stroke prognosis (stroke recurrence, mortality and myocardial infarction) in white non-Hispanic, black non-Hispanic and Hispanic men and women using the Northern Manhattan population. There are 3 components to this study. First, case surveillance will utilize hospital and community based survey networks for enumeration of all first strokes. Strokes will be classified as intracerebral hemorrhage, subarachnoid hemorrhage, or cerebral infarction which will be subdivided based on the results of diagnostic evaluation. Incidence of stroke subtypes by gender and race/ethnicity will be estimated using the numbers from this study and adjusted 1990 census data. Second, cerebral infarction risk factors will be identified through a case-control study where cases (n=800) are uniformly evaluated first cerebral infarct patients and controls (n=1600) randomly selected from the community for stroke risk factor assessments. All eligible subjects will be enrolled, interviewed and examined. Data will be collected systematically through direct interview of the subject or surrogate on demographics, stroke risk factors, neurological examination, fasting lipid profile and results of diagnostic studies. Finally, prospective, annual in-person and semi-annual telephone follow-up of the cerebral infarct cases will measure stroke recurrence, myocardial infarction and functional outcome. Exploratory univariate analyses will be done to identify variables that are marginally dependent on the outcome of interest and confirmatory multivariate analyses will be performed for hypothesis testing with race/ethnicity and gender as independent variables controlling for other risk factors.
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