title: Perceived hardships at midlife: prediction of long-term stroke mortality.
abstract: OBJECTIVE
  The objective of this study is to examine the association between perceived hardships and long-term stroke mortality among a large cohort of middle-aged men.
  
  
  BACKGROUND
  Unlike cardiovascular morbidity and mortality, much less is known about the relationship between psychosocial factors and risk of stroke.
  
  
  METHODS
  A cohort of 10,059 men aged ≥ 40 years at study inclusion that were tenured civil servants or municipal employees were followed for mortality over a median of 28.1 years (IQR 18.9-34.3). During follow-up 6528 (64.9%) men died, 665 of stroke and 1769 of coronary heart disease (CHD). A composite score of perceived hardships was calculated based on a structured psychosocial questionnaire filled at baseline, assessing domains of work, family, and finance. Cox proportional hazard models were used adjusting for traditional risk factors and socio-economic status.
  
  
  RESULTS
  At baseline, subjects with higher hardship scores were slightly older, smoked more cigarettes, had higher prevalence of CHD, lower systolic blood pressure, higher anxiety levels and lower socio-economic status. Compared with the bottom tertile, the middle (HR 1.26, 95% CI 1.04-1.53) and top tertiles of the hardship score (HR 1.33, 95% CI 1.07-1.64) exhibited higher risk of stroke mortality (P for trend=0.008), while no significant association was found with long-term mortality from CHD. The magnitude of the association was comparable to that of diabetes (HR 1.30, 95% CI 1.02-1.66).
  
  
  CONCLUSIONS
  Perceived hardships measured at midlife in a large cohort of apparently healthy men independently predict stroke mortality over long-term follow-up.
authors.affiliation: Stroke Center, Department of Neurology and Sagol Neuroscience Center, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Noa
authors.initials: N
authors.lastname: Molshatzki
authors.forename: Uri
authors.initials: U
authors.lastname: Goldbourt
authors.forename: David
authors.initials: D
authors.lastname: Tanne
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: Coronary heart disease; Psychosocial factors; Stroke