Trajectory of Functional Decline Before and After Ischemic Stroke The Northern Manhattan Study

Background and Purpose-Previous research in our cohort showed a delayed decline in functional status after first ischemic stroke. We compared the long-term trajectory of functional status before and after ischemic stroke. Methods-The Northern Manhattan Study contains a prospective, population-based study of stroke-free individuals age >= 40 years, followed for a median of 11 years. The Barthel index (BI), a commonly used measure of activities of daily living, was assessed annually. Generalized estimating equations were used to assess functional decline over time before stroke and beginning 6 months after stroke. Follow-up was censored at the time of recurrent stroke. Results-Among 3298 participants, 210 participants had an ischemic stroke during follow-up and had poststroke BI assessed. Mean age (+/-SD) was 77 +/- 9 years, 38% were men, 52% were Hispanic, 37% had diabetes, and 31% had coronary artery disease. There was no difference in rate of functional decline over time before and after stroke (P = 0.51), with a decline of 0.96 BI points per year before stroke (P < 0.0001) and 1.24 BI points after stroke (P = 0.001). However, when stratified by insurance status, among those with Medicaid or no insurance, in a fully adjusted model, there was a difference in slope before and after stroke (P = 0.04), with a decline of 0.58 BI points per year before stroke (P = 0.02) and 1.94 BI points after stroke (P = 0.001). Conclusions-In this large, prospective, population-based study with long-term follow-up, there was a significantly steeper decline in functional status after ischemic stroke compared with before stroke among those with Medicaid or no insurance, after adjusting for confounders. (Stroke. 2012; 43: 2180-2184.)