on June 25, 2009
Published online before print June 25, 2009, doi: 10.1161/STROKEAHA.109.549576
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Submitted on February 4, 2009
From the Department of Neurology (M.S.D., B.B.-A., M.S.V.E.), College of Physicians and Surgeons, Columbia University, New York, NY; the Departments of Biostatistics (Y.P.M., M.C.P.) and Sociomedical Sciences (B.B.-A.), Mailman School of Public Health, Columbia University, New York, NY; and the Departments of Neurology (T.R., R.L.S.) and Epidemiology and Human Genetics (R.L.S.), Miller School of Medicine, University of Miami, Miami, Fla. * To whom correspondence should be addressed. E-mail: mdhamoon{at}neuro.columbia.edu.
Background and Purpose—Several factors predict functional status after stroke, but most studies have included hospitalized patients with limited follow-up. We hypothesized that patients with ischemic stroke experience functional decline over 5 years independent of recurrent stroke and other risk factors. Methods—In the population-based Northern Manhattan Study, patients Results—Of 525 patients, mean age was 68.6±12.4 years, 45.5% were male, 54.7% Hispanic, 54.7% had Medicaid/no insurance, and 35.1% had moderate stroke. The proportion with Barthel Index Conclusions—The proportion of patients with functional independence after stroke declines annually for up to 5 years, and these effects are greatest for those with Medicaid or no health insurance. This decline is independent of age, stroke severity, and other predictors of functional decline and occurs even among those without recurrent stroke or myocardial infarction.
Accepted on March 19, 2009
Long-Term Functional Recovery After First Ischemic Stroke. The Northern Manhattan Study
Mandip S. Dhamoon MD, MPH*;
40 years of age with incident ischemic stroke were prospectively followed using the Barthel Index at 6 months and annually to 5 years. Baseline stroke severity was categorized as mild (National Institutes of Health Stroke Scale <6), moderate (6 to 13), and severe (14). Follow-up was censored at death, recurrent stroke, or myocardial infarction. Generalized Estimating Equations provided ORs and 95% CIs for predictors of favorable (Barthel Index 95) versus unfavorable (Barthel Index <95) functional status after adjusting for demographic and medical risk factors.95 declined over time (OR, 0.91; 95% CI, 0.84 to 0.99). Changes in Barthel Index by insurance status were confirmed by a significant interaction term (
for interaction=-0.167, P=0.034); those with Medicaid/no insurance declined (OR, 0.84; P=0.003), whereas those with Medicare/private insurance did not (OR, 0.99; P=0.92).
Key words: disability • recovery • stroke