Social isolation and outcomes post stroke
Social isolation and outcomes post stroke
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DOI：
10.1212/01.wnl.0000163510.79351.af
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发表时间：
2005-06-14
期刊：
影响因子：
9.9
通讯作者：
Sacco, RL
中科院分区：
文献类型：
--
作者：
Boden-Albala, B;Litwak, E;Sacco, RL
目的：在多种族队列中评估社会隔离与卒中结局之间的关系。方法：作为北方曼哈顿卒中研究的一部分，作者前瞻性随访了一组卒中患者5年。收集了包括社会隔离在内的基线数据。在随访时，作者记录了结局事件，定义为首次发生心肌梗死（MI）、卒中复发或死亡。采用考克斯风险模型计算卒中前预测卒中后结局的风险比（HR，95% CI）。结果：作者随访了655例缺血性卒中患者，平均随访时间为5年。该队列为55%的女性; 17%的白色，27%的非洲裔美国人，54%的西班牙裔;平均年龄69 ± 12岁。共有265例首次结局事件。在单变量分析中，冠状动脉疾病（OR 1.3，1.0至1.7），年龄> 70岁（OR 1.9，1.5至2.5），房颤（AF）（OR 1.8，1.3 - 2.5），人种-种族（白色vs西班牙裔）（OR 1.7，1.1至2.9），缺乏体力活动（OR 1.3，1.1至2.6），在家帮助（OR 1.8，1.4至2.4）和社会孤立（OR 1.4，1.2至1.6）与结果事件的风险增加相关。高血压、糖尿病、教育程度、性别、保险、职业、婚姻状况或初级保健医生均未发现相关性。在控制年龄的多变量模型中，AF（OR 1.9，1.5至2.5），家庭帮助（OR 1.5，1.1至2.0）和社会隔离（OR 1.4，1.1至1.8）预测结局事件。结论：卒中前社会隔离是卒中后结局事件的预测因子。缺乏社会支持可能会导致更差的结果，因为依从性差，抑郁和压力。
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.