Quality of life declines after first ischemic stroke: The Northern Manhattan Study

M. S. Dhamoon, Y. P. Moon, M. C. Paik, B. Boden-Albala, Tatjana Rundek, Ralph L Sacco, M. S V Elkind

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI). METHODS: In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI. RESULTS: There were 525 incident ischemic stroke patients â‰1-40 years (mean age 68.6 ± 12.4 years). QLI declined after stroke (annual change-0.10, 95% confidence interval-0.17 to-0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI â‰1-95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98). CONCLUSIONS: In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.

Original languageEnglish
Pages (from-to)328-334
Number of pages7
JournalNeurology
Volume75
Issue number4
DOIs
StatePublished - Jul 27 2010

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Stroke
Quality of Life
Insurance
Myocardial Infarction
Medicaid
Cognition
Survivors
Recurrence
Insurance Coverage
Urinary Incontinence
Medicare
Natural History
Population
Urinary Bladder
Confidence Intervals
Education

ASJC Scopus subject areas

  • Clinical Neurology

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Quality of life declines after first ischemic stroke : The Northern Manhattan Study. / Dhamoon, M. S.; Moon, Y. P.; Paik, M. C.; Boden-Albala, B.; Rundek, Tatjana; Sacco, Ralph L; Elkind, M. S V.

In: Neurology, Vol. 75, No. 4, 27.07.2010, p. 328-334.

Research output: Contribution to journalArticle

Dhamoon, M. S. ; Moon, Y. P. ; Paik, M. C. ; Boden-Albala, B. ; Rundek, Tatjana ; Sacco, Ralph L ; Elkind, M. S V. / Quality of life declines after first ischemic stroke : The Northern Manhattan Study. In: Neurology. 2010 ; Vol. 75, No. 4. pp. 328-334.
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AU - Moon, Y. P.

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AU - Sacco, Ralph L

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N2 - OBJECTIVES: Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI). METHODS: In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI. RESULTS: There were 525 incident ischemic stroke patients â‰1-40 years (mean age 68.6 ± 12.4 years). QLI declined after stroke (annual change-0.10, 95% confidence interval-0.17 to-0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI â‰1-95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98). CONCLUSIONS: In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.

AB - OBJECTIVES: Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI). METHODS: In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI. RESULTS: There were 525 incident ischemic stroke patients â‰1-40 years (mean age 68.6 ± 12.4 years). QLI declined after stroke (annual change-0.10, 95% confidence interval-0.17 to-0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI â‰1-95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98). CONCLUSIONS: In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.

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