Social isolation and outcomes post stroke
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.
Get full access to this article
View all available purchase options and get full access to this article.
References
1.
Lantz PM, House JS, Lepkowski JM, et al. Socioeconomic factors, health behaviors, and mortality: results from a nationally representative prospective study of US adults. JAMA 1998;279:1703–1708.
2.
Lynch JW, Kaplan GA, Cohen RD, et al. Do cardiovascular risk factors explain the relation between socioeconomic status, risk of all-cause mortality, cardiovascular mortality, and acute myocardial infarction? Am J Epidemiol 1996;144:934–942.
3.
Howard G, Anderson RT, Russell G, et al. Race, socioeconomic status, and cause-specific mortality. Ann Epidemiol 2000;10:214–223.
4.
Casper M, Wing S, Strogatz D. Variation in the magnitude of black-white differences in stroke mortality by community occupational structure. J Epidemiol Community Health 1991;45:302–306.
5.
Casper ML, Barnett EB, Armstrong DL, Giles WH, Blanton CJ. Social class and race disparities in premature stroke mortality among men in North Carolina. Ann Epidemiol 1997;7:146–153.
6.
Jakovljevic D, Sarti C, Sivenius J, Torppa T. Socioeconomic status and ischemic stroke: The FINMONICA Stroke Register. Stroke 2001;32:1492–1498.
7.
Kunst AE, del Rios M, Groenhof F, Machenbach JP. Socioeconomic inequalities in stroke mortality among middle-aged men: an international overview. European Union Working Group on Socioeconomic Inequalities in Health. Stroke 1998;29:2285–2291.
8.
Gillum RF, Ingram DD. Relation between residence in the southeast region of the United States and stroke incidence. The NHANES I Epidemiologic Follow-up Study. Am J Epidemiol 1996;144:665–673.
9.
van Rossum CT, Vandemheen H, Breteler MM, Grobbee DE, Mackenbach JP. Socioeconomic differences in stroke among Dutch elderly women: the Rotterdam Study. Stroke 1999;30:357–362.
10.
Hames CG, Greenlund KJ. Ethnicity and cardiovascular disease: The Evans County Heart Study. Am J Med Sci 1996;311:130–134.
11.
Lackland DT, Egan BM, Jones PJ. Impact of nativity and race on “Stroke Belt” mortality. Hypertension 1999;34:57–62.
12.
Gillum RF. Epidemiology of stroke in Hispanic Americans. Stroke 1995;26:1707–1712.
13.
Kattapong VJ, Becker TM. Ethnic differences in mortality from cerebrovascular disease among New Mexico’s Hispanics, Native Americans, and non-Hispanic whites, 1958 through 1987. Ethn Dis 1993;3:75–82.
14.
Liberatos P, Link BG, Kelsey JL. The measurement of social class in epidemiology. Epidemiol Rev 1988;10:87–121.
15.
Sacco RL, Elkind M, Boden-Albala, et al. The protective effect of moderate alcohol consumption on ischemic stroke. JAMA 1999;281:53–60.
16.
Sacco RL, Shi T, Zamarillo MC, Kargman DE. Predictors of mortality and recurrence after hospitalized cerebral infarction in an urban community: the Northern Manhattan Stroke Study. Neurology 1994;44:626–634.
17.
Alter M, Sobel E, McCoy RL, et al. Stroke in the Lehigh Valley: risk factors for recurrent stroke. Neurology 1987;37:503–507.
18.
Sacco RL. Secondary prevention of ischemic stroke: a 1998 US perspective. Cerebrovasc Dis 1999;9:37–44.
19.
Berkman LF. The relationship of social networks and social support to morbidity and mortality. In: Cohen SS, ed. Social support and health. New York: Academic Press, 1985;240–259.
20.
Berkman LF, Syme SL. Social networks, host resistance, and mortality: a nine-year follow-up study of Alameda County residents. Am J Epidemiol 1979;109:186–204.
21.
House JS, Robbins C, Metzner HL. The association of social relationships and activities with mortality: prospective evidence from the Tecumseh Community Health Study. Am J Epidemiol 1982;116:123–140.
22.
Schoenbach VJ, Kaplan BH, Fredman L, Kleinbaum DG. Social ties and mortality in Evans County, Georgia. Am J Epidemiol 1986;123:577–591.
23.
Orth-Gomer K, Johnson JV. Social network interaction and mortality. A six year follow-up study of a random sample of the Swedish population. J Chronic Dis 1987;40:949–957.
24.
Michael YL, Coldits GA, Coakley E, Kawachi I. Health behaviors, social networks, and healthy aging: cross-sectional evidence from the Nurses’ Health Study. Qual Life Res 1999;8:711–722.
25.
Knox SS, Siegmund KD, Weidner G, et al. Hostility, social support, and coronary heart disease in the National Heart, Lung, and Blood Institute Family Heart Study. Am J Cardiol 1998;82:1192–1196.
26.
Vogt TM, Mullooly JP, Ernst D, Pope CR, Hollis JF. Social networks as predictors of ischemic heart disease, cancer, stroke and hypertension: incidence, survival and mortality. J Clin Epidemiol 1992;45:659–666.
27.
Brummett B, Barefoot BH, Siegler IC, et al. Characteristics of socially isolated patients with coronary artery disease who are at elevated risk for mortality. Psychosom Med 2001;63:267–272.
28.
House J, Landis K, Umberson D. Social relationships and health. Science 1988;241:540–545.
29.
Litwak E. Complementary roles for formal and informal support groups: a study of nursing homes and mortality rates. J Appl Behav Sci 1985;21:407–425.
30.
Litwak E, Silverstein M. Helping networks among the Jewish elderly poor. Contemporary Jewry 1990;11:3–48.
31.
Messeri P, Silverstein M, Litwak E. Choosing optimal support groups: a review and reformulation. J Health Soc Behav 1993;34:122–137.
32.
Silverstein M, Litwak E. A task-specific typology of intergenerational family structure in later life. Gerontologist 1993;33:258–264.
33.
Waite L. Does marriage matter? Demography 1995;32:483–507.
Information & Authors
Information
Published In
Copyright
© 2005.
Publication History
Published online: June 13, 2005
Published in issue: June 14, 2005
Authors
Metrics & Citations
Metrics
Citation information is sourced from Crossref Cited-by service.
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Parvalbumin interneurons regulate rehabilitation-induced functional recovery after stroke and identify a rehabilitation drug, Nature Communications, 16, 1, (2025).https://doi.org/10.1038/s41467-025-57860-0
- Double language scarcity: narrative accounts of spiritual and existential needs in aphasia, Aphasiology, (1-21), (2025).https://doi.org/10.1080/02687038.2025.2451656
- JCS/JCC/JACR/JATS 2024 Guideline on Cardiovascular Practice With Consideration for Diversity, Equity, and Inclusion, Circulation Journal, (2025).https://doi.org/10.1253/circj.CJ-23-0890
- An Age-Old Debate: Driving Cessation Conversations in the Emergency Department, Annals of Emergency Medicine, (2025).https://doi.org/10.1016/j.annemergmed.2025.01.015
- Topic: Evaluation and Treatment of Social Isolation and Loneliness: Evidence-based Recommendations for Stroke and Neurological Rehabilitation, Current Physical Medicine and Rehabilitation Reports, 13, 1, (2025).https://doi.org/10.1007/s40141-025-00477-7
- Multifactorial interplay on language recovery following left‐hemispheric stroke: A retrospective study, Journal of Neuropsychology, (2024).https://doi.org/10.1111/jnp.12406
- Stroke and liminality: narratives of reconfiguring identity after stroke and their implications for person-centred stroke care, Frontiers in Rehabilitation Sciences, 5, (2024).https://doi.org/10.3389/fresc.2024.1477414
- Efficacy and safety of DL ‐3‐N‐butylphthalide in the treatment of ischemic poststroke aphasia: A randomized clinical trial , Annals of Clinical and Translational Neurology, 11, 12, (3300-3309), (2024).https://doi.org/10.1002/acn3.52238
- Right hemisphere stroke is linked to reduced social connectedness in the UK Biobank cohort, Scientific Reports, 14, 1, (2024).https://doi.org/10.1038/s41598-024-78351-0
- Development and validation of a risk prediction model for older adults with social isolation in China, BMC Public Health, 24, 1, (2024).https://doi.org/10.1186/s12889-024-20142-3
- See more
Loading...
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.