Understanding Cohort Effects on Stroke, VCID, and Cognition After Major Epidemiologic Transitions
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PROJECT SUMMARY/ABSTRACT Stroke mortality has always been higher for Black Americans and for those living in the American Southeast, aka the Stroke Belt. The REGARDS study has been examining racial and geographic differences in stroke incidence and cognitive function (including cognitive impairment, cognitive decline and dementia) since 2003. This cohort of 30,239 people from across the lower 48 United States has been active for more than 20 years with a 97% annual retention rate and has generated >700 publications creating a truly unique scientific resource. Leveraging the rich, expansive data collected by REGARDS will be critical to understand major societal changes and epidemiologic transitions including: rise in obesity, COVID-19, and widening disparities due to social structures. Even before the COVID-19 pandemic, America experienced an inflection point when the long-persisting improvement in life expectancy stagnated and began reversing. Life expectancy has been declining since 2014 in part driven by increased stroke mortality. This alarming trend places the US as discordant from most developed nations as most have continued to experience increasing life expectancy. The REGARDS study is ideal for understanding how racial disparities in stroke and stroke risk factors such as cognitive decline, biomarkers of brain injury, social determinants of health, diet, and blood pressure are contributing to wider declines in life expectancy in the US. Through this new round of funding, we propose to create the REGARDS-2 cohort consisting of 8000 participants followed since baseline (2003-07, born between born 1908-1960) and 12000 new younger participants aged 45-64 (born between 1961 and 1980). Aim 1 examines the role of secular changes in stroke and dementia risk factors comparing 15,326 individuals who were 45-64 in 2003-2007 (middle aged Baby Boomer Generation) with 12,000 individuals who are 45-64 in 2024-2027 (middle aged Generation X). We will further explore how changes in risk factors in middle aged adults are driving increases in stroke incidence and Alzheimer’s Disease and Related Dementia (ADRD). For Aim 2, we will build on the large biomarker repository to examine whether emerging ADRD blood-based biomarkers are associated with incident ADRD and stroke. To support bi-directional communication with the REGARDS research community and the REGARDS participant community, we propose an Infrastructure Aim to establish a participant advisory board and structured mentoring for scientists, particularly those from backgrounds under-represented in research, interested in working in health disparities in stroke and dementia. The REGARDS study has been and will continue to be a strong platform for developing future scientists interested in understanding and addressing health disparities in Black and White Americans.
