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Abstract

Objective: To assess the relationship between social isolation and stroke outcomes in a multiethnic cohort.
Methods: As part of the Northern Manhattan Stroke Study, the authors prospectively followed a cohort of patients with stroke for 5 years. Baseline data including social isolation were collected. At follow-up, the authors documented outcome events as defined by the first occurrence of myocardial infarction (MI), stroke recurrence, or death. Cox hazard models were used to calculate the hazard ratio (HR, 95% CI) for prestroke predictors of post stroke outcomes.
Results: The authors followed 655 ischemic stroke cases for a mean of 5 years. The cohort was 55% women; 17% white, 27% African American, 54% Hispanic; mean age 69 ± 12 years. There were 265 first outcome events. In univariate analysis, coronary artery disease (OR 1.3, 1.0 to 1.7), age > 70 years (OR 1.9, 1.5 to 2.5), atrial fibrillation (AF) (OR 1.8, 1.3 to 2.5), race-ethnicity (white vs Hispanic) (OR 1.7, 1.1 to 2.9), physical inactivity (OR 1.3, 1.1 to 2.6), help at home (OR 1.8, 1.4 to 2.4), and social isolation (OR 1.4, 1.2 to 1.6) were associated with increased risk of an outcome event. No association was seen for hypertension, diabetes, education, sex, insurance, occupation, marital status, or primary care physician. In the multivariable model controlling for age, AF (OR 1.9, 1.5 to 2.5), help at home (OR 1.5, 1.1 to 2.0), and social isolation (OR 1.4, 1.1 to 1.8) predicted outcome events.
Conclusion: Prestroke social isolation is a predictor of outcome events post stroke. Lack of social support may contribute to poorer outcomes due to poor compliance, depression, and stress.

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Information & Authors

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Published In

Neurology®
Volume 64Number 11June 14, 2005
Pages: 1888-1892
PubMed: 15955939

Publication History

Published online: June 13, 2005
Published in print: June 14, 2005

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Authors

Affiliations & Disclosures

B. Boden-Albala, MPH, DrPH
From the Departments of Neurology (Drs. Boden-Albala, Elkind, Rundek, and Sacco) and Sociomedical Science (Drs. Boden-Albala and Litwak), Sergievsky Center (Dr. Sacco), and Department of Epidemiology (Dr. Sacco), Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY.
E. Litwak, PhD
From the Departments of Neurology (Drs. Boden-Albala, Elkind, Rundek, and Sacco) and Sociomedical Science (Drs. Boden-Albala and Litwak), Sergievsky Center (Dr. Sacco), and Department of Epidemiology (Dr. Sacco), Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY.
M.S.V. Elkind, MD, MS
From the Departments of Neurology (Drs. Boden-Albala, Elkind, Rundek, and Sacco) and Sociomedical Science (Drs. Boden-Albala and Litwak), Sergievsky Center (Dr. Sacco), and Department of Epidemiology (Dr. Sacco), Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY.
T. Rundek, MD, PhD
From the Departments of Neurology (Drs. Boden-Albala, Elkind, Rundek, and Sacco) and Sociomedical Science (Drs. Boden-Albala and Litwak), Sergievsky Center (Dr. Sacco), and Department of Epidemiology (Dr. Sacco), Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY.
R. L. Sacco, MD, MS
From the Departments of Neurology (Drs. Boden-Albala, Elkind, Rundek, and Sacco) and Sociomedical Science (Drs. Boden-Albala and Litwak), Sergievsky Center (Dr. Sacco), and Department of Epidemiology (Dr. Sacco), Columbia University College of Physicians and Surgeons and the Mailman School of Public Health, New York, NY.

Notes

Address correspondence and reprint requests to Dr. Bernadette Boden-Albala, Neurologic Institute, 710 West 168 Street, New York, NY 10032; e-mail: [email protected]

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