Long-term functional recovery after first ischemic stroke

The Northern manhattan study

Mandip S. Dhamoon, Yeseon Park Moon, Myunghee C. Paik, Bernadette Boden-Albala, Tatjana Rundek, Ralph L. Sacco, Mitchell S V Elkind

Research output: Contribution to journalArticle

Abstract

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 ≥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. 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 ≥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 (β 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). 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.

Original languageEnglish (US)
Pages (from-to)2805-2811
Number of pages7
JournalStroke
Volume40
Issue number8
DOIs
StatePublished - Aug 2009

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Stroke
Medicaid
Insurance
Myocardial Infarction
Insurance Coverage
National Institutes of Health (U.S.)
Health Insurance
Medicare
Hispanic Americans
Demography
Population

Keywords

  • Disability
  • Recovery
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialized Nursing

Cite this

Dhamoon, M. S., Moon, Y. P., Paik, M. C., Boden-Albala, B., Rundek, T., Sacco, R. L., & Elkind, M. S. V. (2009). Long-term functional recovery after first ischemic stroke: The Northern manhattan study. Stroke, 40(8), 2805-2811. https://doi.org/10.1161/STROKEAHA.109.549576

Long-term functional recovery after first ischemic stroke : The Northern manhattan study. / Dhamoon, Mandip S.; Moon, Yeseon Park; Paik, Myunghee C.; Boden-Albala, Bernadette; Rundek, Tatjana; Sacco, Ralph L.; Elkind, Mitchell S V.

In: Stroke, Vol. 40, No. 8, 08.2009, p. 2805-2811.

Research output: Contribution to journalArticle

Dhamoon, MS, Moon, YP, Paik, MC, Boden-Albala, B, Rundek, T, Sacco, RL & Elkind, MSV 2009, 'Long-term functional recovery after first ischemic stroke: The Northern manhattan study', Stroke, vol. 40, no. 8, pp. 2805-2811. https://doi.org/10.1161/STROKEAHA.109.549576
Dhamoon, Mandip S. ; Moon, Yeseon Park ; Paik, Myunghee C. ; Boden-Albala, Bernadette ; Rundek, Tatjana ; Sacco, Ralph L. ; Elkind, Mitchell S V. / Long-term functional recovery after first ischemic stroke : The Northern manhattan study. In: Stroke. 2009 ; Vol. 40, No. 8. pp. 2805-2811.
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abstract = "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 ≥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. 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 ≥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 (β 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). 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.",
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