The disability burden associated with stroke emerges before stroke onset and differentially affects blacks: Results from the health and retirement study cohort

Benjamin D. Capistrant, Nicte I. Mejia, Sze Y. Liu, Qianyi Wang, M. Maria Glymour

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

Background. Few longitudinal studies compare changes in instrumental activities of daily living (IADLs) among stroke-free adults to prospectively document IADL changes among adults who experience stroke. We contrast annual declines in IADL independence for older individuals who remain stroke free to those for individuals who experienced stroke. We also assess whether these patterns differ by sex, race, or Southern birthplace. Methods. Health and Retirement Study participants who were stroke free in 1998 (n = 17,741) were followed through 2010 (average follow-up = 8.9 years) for self- or proxy-reported stroke. We used logistic regressions to compare annual changes in odds of self-reported independence in six IADLs among those who remained stroke free throughout follow-up (n = 15,888), those who survived a stroke (n = 1,412), and those who had a stroke and did not survive to participate in another interview (n = 442). We present models adjusted for demographic and socioeconomic covariates and also stratified on sex, race, and Southern birthplace. Results. Compared with similar cohort members who remained stroke free, participants who developed stroke had faster declines in IADL independence and lower probability of IADL independence prior to stroke. After stroke, independence declined at an annual rate similar to those who did not have stroke. The black-white disparity in IADL independence narrowed poststroke. Conclusion. Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.

Original languageEnglish (US)
Pages (from-to)860-870
Number of pages11
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume69
Issue number7
DOIs
StatePublished - Jul 1 2014

Bibliographical note

Funding Information:
Supplementary Material Supplementary material can be found at: http://biomedgerontology. oxfordjournals.org/ Funding This work was supported by the National Institutes of Health (R21 AG034385, T32 HD007168, R24 HD050924) and American Heart Association (10SDG2640243). The U.S. Health and Retirement Study (HRS), conducted by the University of Michigan, is sponsored by the National Institute on Aging (NIA U01AG009740).

Keywords

  • Cardiovascular
  • Disablement process
  • Epidemiology
  • Minority aging
  • Stroke

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