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

• Published in: Neurology Vol. 75; no. 4; p. 328
• Main Authors: Dhamoon, M S, Moon, Y P, Paik, M C, Boden-Albala, B, Rundek, T, Sacco, R L, Elkind, M S V
• Format: Journal Article
• Language: English
• Published: United States 27.07.2010
• Subjects: Adult; Aged; Aged, 80 and over; Brain Ischemia - epidemiology; Brain Ischemia - physiopathology; Brain Ischemia - psychology; Disease-Free Survival; Female; Follow-Up Studies; Humans; Incidence; Insurance, Health - statistics & numerical data; Male; Medicaid - statistics & numerical data; New York City - epidemiology; Prospective Studies; Psychiatric Status Rating Scales; Quality of Life; Recovery of Function; Recurrence; Risk Factors; Stroke - epidemiology; Stroke - physiopathology; Stroke - psychology; United States; Urban Population - statistics & numerical data; New York City; United States
• ISSN: 1526-632X
• DOI: 10.1212/WNL.0b013e3181ea9f03

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). 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. There were 525 incident ischemic stroke patients >/=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 >/=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). 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.