(Stroke. 2000;31:2354.)
© 2000 American Heart Association, Inc.
Original Contributions |
Predictors of Survival Among Elders Suffering Strokes in Taiwan
Observation From a Nationally Representative Sample
From the Departments of Public Health (S.-L.W., S.-P.C.) and Family Medicine (M.-C.L.), Chung Shan Dental and Medical College, and National Institute of Family Planning, Department of Health, Executive Yuan (M.-C.C.), Taichung, Taiwan; and the Division of Epidemiology and Public Health, Institute of Biomedical Sciences, Academia Sinica, and School of Public Health, National Taiwan University (W.-H.P.), Taipei, Taiwan, ROC.
Correspondence and reprint requests to Shu-Li Wang, Division of Evironmental Health and Occupational Medicine, National Health Research Institutes (NHRI), No. 100, Shih-Chuan 1st Road, Kaohsiung 807, Taiwan ROC. E-mail wang21{at}nhri.org.tw
Background and Purpose—Cerebrovascular disease was the leading cause of death in Taiwan from 1963 to 1982. Deaths due to stroke now rank second only to cancer, with more deaths resulting from strokes than from any other single pathology. It is important to understand stroke prognosis among elderly stroke survivors, with respect to survival and attendant predictive factors, because aged population in Taiwan is growing rapidly. The aim of the present study was to discern factors affecting survival in stroke patients from a nationally representative elderly sample.
Methods—A total of 99 stroke survivors, from a
representative national sample of elders aged 
65
years on December 31, 1988, whose strokes occurred in the period
1989–1993, were followed for mortality until July 1, 1995. Personal
data were gathered through home interviews conducted by well-trained
community nurses, and mortality data were obtained from the national
census office by using identification card numbers. Cox proportional
hazards regression analysis and the stepwise technique were
used to search for important prognostic factors of survival.
Results—Women experienced a higher mortality rate (139.8 per 1000 person-years) than men (126.4 per 1000 person-years), as age-adjusted for World Health Organization world-population figures. Stroke patients who received continuous treatment for diabetes experienced mortality risks similar to those of patients without diabetes and much lower risks than those with discontinuous diabetes treatment. Cognitive impairment was also an independent predictor of survival (relative risk 2.69, P<0.05). In addition, patients with both cognitive and mobility impairments had a 2- to 3-fold greater risk of mortality than those with only a single abnormality.
Conclusions—This first report on the various prognostic factors related to survival of elderly stroke patients in Taiwan’s Chinese population emphasized the benefit of continuous diabetes treatment in improving survival chances. These stroke patients should also be monitored for cognitive and mobility impairments and undergo rehabilitation.
Key Words: elderly • epidemiology • stroke outcome • survival
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