title: Fatal stroke after the death of a sibling: a nationwide follow-up study from Sweden.
abstract: BACKGROUND
  Although less studied than other types of familial losses, the loss of a sibling could be a potential trigger of stroke as it represents a stressful life event. We studied the association between loss of a sibling and fatal stroke up to 18 years since bereavement.
  
  
  RESULTS
  We conducted a follow-up study between 1981 and 2002, based on register data covering the total population of Swedes aged 40-69 years (n = 1,617,010). An increased risk of fatal stroke (1.31 CI: 1.05, 1.62) was found among women who had experienced the loss of a sibling. No increase in the overall mortality risk was found in men (1.11 CI: 0.92, 1.33). An elevated risk in the short term (during the second and third half-year after the death) was found among both men and women, whereas longer-term elevation in risk was found primarily for women. Both external (1.47 CI: 1.00, 2.17) and not external (1.26 CI: 1.00, 1.60) causes of sibling death showed associations among women. In men, an association was found only if the sibling also died from stroke (1.78 CI: 1.00, 3.17). However, among women, we found an increased risk of stroke mortality if the sibling died from causes other than stroke (1.30 CI: 1.04, 1.62).
  
  
  CONCLUSIONS
  The findings suggest an increased risk of dying from stroke mortality after the death of a sibling, and that bereavement affects particularly women. It is important for health care workers to follow bereaved siblings and recognize potential changes of stress-levels and health related behaviours that could lead to risk of stroke.
authors: Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden. mikael.rostila@chess.su.se
authors: Mikael
authors: M
authors: Rostila
authors: Jan
authors: J
authors: Saarela
authors: Ichiro
authors: I
authors: Kawachi
mesh_terms: D000328:Adult; D000368:Aged; D003643:Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D035781:Siblings; D020521:Stroke / Q000401:mortality*; D013548:Sweden / Q000453:epidemiology