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


CONCLUSIONS
Racial differences in IADL independence are apparent long before stroke onset. Poststroke differences in IADL independence largely reflect prestroke disparities.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis. bcapistr@umn.edu.
Benjamin D
BD
Capistrant
Department of Neurology, Massachusetts General Hospital, Boston. Department of Neurology, Harvard Medical School, Boston, Massachusetts.
Nicte I
NI
Mejia
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts.
Sze Y
SY
Liu
Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts.
Qianyi
Q
Wang
Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts. Department of Epidemiology & Biostatistics, University of California - San Francisco.
M Maria
MM
Glymour
D000203:Activities of Daily Living; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D015331:Cohort Studies; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology*; D014481:United States / Q000453:epidemiology; D044465:White People
Cardiovascular; Disablement process; Epidemiology.; Minority aging; Stroke