Diabetes predicts long-term disability in an elderly urban cohort: the Northern Manhattan Study.
OBJECTIVE
There are limited data on vascular predictors of long-term disability in Hispanics. We hypothesized that (1) functional status declines over time and (2) vascular risk factors predict functional decline.


METHODS
The Northern Manhattan Study contains a population-based study of 3298 stroke-free individuals aged 40 years or older, followed for median 11 years. The Barthel Index (BI) was assessed annually. Generalized estimating equations and Cox models were adjusted for demographic, medical, and social risk factors. Stroke and myocardial infarction occurring during follow-up were censored in sensitivity analysis. Secondarily, motor and nonmotor domains of the BI were analyzed.


RESULTS
Mean age (standard deviation) of the cohort (n = 3298) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% diabetic, and 74% hypertensive. There was a mean annual decline of 1.02 BI points (P < .0001). Predictors of decline in BI included age, female sex, diabetes, depression, and normocholesterolemia. Results did not change with censoring. We found similar predictors of BI for motor and nonmotor domains.


CONCLUSIONS
In this large, population-based, multiethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when vascular events were censored. Diabetes predicted functional decline in the absence of clinical vascular events.
Department of Neurology, Mount Sinai School of Medicine, New York, NY. Electronic address: mandip.dhamoon@mssm.edu.
Mandip S
MS
Dhamoon
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
Yeseon Park
YP
Moon
Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY.
Myunghee C
MC
Paik
Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, FL; Department of Public Health Sciences and Human Genetics, Miller School of Medicine, University of Miami, FL; Department of Human Genetics, Miller School of Medicine, University of Miami, FL.
Ralph L
RL
Sacco
Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY.
Mitchell S V
MS
Elkind
D000203:Activities of Daily Living; D000328:Adult; D001741:Black or African American; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000208:ethnology / Q000503:physiopathology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009519:New York City / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D014504:Urban Health / Q000208:ethnology / Q000706:statistics & numerical data*
Disability; Epidemiology; Stroke