We seek to continue our population-based study of stroke incidence and case fatality, prevalence of risk factors, stroke treatment, and post-stroke outcomes within a biracial metropolitan population of 1,368,604 of whom 223,417 (16.3%) are of black race (US Census 2010). The proposed work will involve an anticipated ~3,750 patients with 4,250 strokes and/or transient ischemic attacks from our region in 2014/2015, an estimated ~600 recurrent strokes from 2015-2018 (following all strokes and transient ischemic attacks for 3 years after the original 2014/2015 event), as well as 2,000 survey participants. For almost 20 years, we have studied trends in stroke incidence and case fatality and have demonstrated a racial disparity where stroke incidence in African-Americans is more than double that of whites. In each prior study period, we have also examined the prevalence of risk factors (and knowledge of stroke) via a population survey in order to put our temporal trend findings into context. In addition to continuing these important activities, we seek to examine stroke recurrence in a population- based fashion (which has not been done since the 1990's) with the goal of identifying whether there is a racial disparity in stroke recurrence. We propose an innovative pilot study to determine if we can estimate functional outcome and place of residence at 3- and 6-months post-stroke without patient contact, using a local health- information exchange (HIE) and electronic health record. We will compare our estimate to phone interviews with the subject as the gold standard; the phone interview to be used was successfully piloted in the current period. Finally, we have used our data to inform eligibility for stroke clinical trils. We propose to share our data with the scientific community for this purpose. In our proposed work, we will have data regarding acute stroke presentation and will add information about stroke recurrence and post-stroke functional outcomes that can be used for rational planning of stroke interventions in all phases of stroke (acute, secondary prevention, recovery). In all of th proposed activities, the use of the HIE will make the proposed work possible (harnessing the power of centralized health data) and will be important for accomplishing the work efficiently. Overall, our proposed study will accomplish more than prior periods in a shorter time and without increased cost.
The change in stroke occurrence and recurrence 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 20 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, recurrence, cause, treatment, and outcome in a biracial metropolitan population.
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