Stroke continues to have a great impact on the public health of the US, and stroke recurrence is undoubtedly a major contributor to the morbidity, mortality and cost of stroke. The frequency, determinants, and cost of stroke recurrence are major gaps in our epidemiologic knowledge. Clarification of these issues will provide scientific rationale for the development of risk-factor modification programs in urban communities and will assist in accomplishing Aim 15.2 of Healthy People 2000.
The aims of this revised competitive continuation are to compare outcomes after cerebral infarction among white (non-Hispanic), black (non-Hispanic) and Hispanic men and women residents of northern Manhattan, determine risk factors for recurrence and death, compare survival after stroke to a stroke-free population sample, identify the frequency of risk factor modification, calculate the direct and indirect costs of stroke recurrence, and develop a stroke recurrence and mortality prediction model. This prospective cohort study will follow 500 patients with first cerebral infarction and 500 stroke-free subjects. The stroke-free cohort will be derived from a random sample of the northern Manhattan population and be frequency matched to our stroke cohort by age, gender, and race- ethnicity. All subjects will be evaluated annually in-person for 5 years to detect morbidity following stroke, diagnose new stroke occurrence, measure functional and cognitive status, and monitor for changes in stroke risk factors and other behaviors, particularly glycemic and blood pressure control, and alcohol consumption. Deaths will be ascertained and the primary cause identified. Survival and stroke recurrence will be compared using Kaplan-Meier techniques in the individual race-ethnic groups. Relative risks for death, vascular death, and stroke recurrence will be calculated for individual risk factors in the stroke cohort and evaluated using Cox-proportional hazards models. Survival after 30-days in the stroke cohort will be compared to the stroke-free cohort after controlling for potential confounders. Risk factor modifications will be compared in these two cohorts and their effect on outcomes assessed using time dependent covariates.
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