Neurological Institute, Department of Neurology, College of Physicians and Surgeons, Columbia University, 710 W. 168th Street, New York, NY 10032, USA.
Neurology. 2010 Jul 27;75(4):328-34. doi: 10.1212/WNL.0b013e3181ea9f03. Epub 2010 Jun 23.
Quality of life (QOL) after stroke is poorly characterized. We sought to determine long-term natural history and predictors of QOL among first ischemic stroke survivors without stroke recurrence or myocardial infarction (MI).
In the population-based, multiethnic Northern Manhattan Study, QOL was prospectively assessed at 6 months and annually for 5 years using the Spitzer QOL index (QLI), a 10-point scale. Functional status was assessed using the Barthel Index (BI) at regular intervals, and cognition using the Mini-Mental State Examination at 1 year. Generalized estimating equations estimated the association between patient characteristics and repeated QOL measures over 5 years. Follow-up was censored at death, recurrent stroke, or MI.
There were 525 incident ischemic stroke patients >/=40 years (mean age 68.6 +/- 12.4 years). QLI declined after stroke (annual change -0.10, 95% confidence interval -0.17 to -0.04), after adjusting for age, sex, race-ethnicity, education, insurance, depressed mood, stroke severity, bladder continence, and stroke laterality. This decline remained when BI >/=95 was added to the model as a time-dependent covariate, and functional status also predicted QLI. Changes in QLI over time differed by insurance status (p for interaction = 0.0017), with a decline for those with Medicaid/no insurance (p < 0.0001) but not Medicare/private insurance (p = 0.98).
In this population-based study, QOL declined annually up to 5 years after stroke among survivors free of recurrence or MI and independently of other risk factors. QLI declined more among Medicaid patients and was associated with age, mood, stroke severity, urinary incontinence, functional status, cognition, and stroke laterality.
卒中后生活质量（QOL）的描述较差。我们旨在确定无卒中复发或心肌梗死（MI）的首发缺血性卒中幸存者的长期自然史及其 QOL 的预测因素。
在基于人群的多民族北曼哈顿研究中，使用 Spitzer QOL 指数（QLI）前瞻性评估了 6 个月和每年 5 年的 QOL，QLI 是一个 10 分制。使用巴氏量表（BI）定期评估功能状态，使用简易精神状态检查（MMSE）在 1 年内评估认知功能。广义估计方程估计了患者特征与 5 年内重复 QOL 测量之间的关联。随访以死亡、复发性卒中或 MI 为终点。
共有 525 例年龄>40 岁的首发缺血性卒中患者（平均年龄 68.6 ± 12.4 岁）。卒中后 QLI 下降（年变化-0.10，95%置信区间-0.17 至-0.04），调整年龄、性别、种族、教育、保险、抑郁情绪、卒中严重程度、膀胱控尿和卒中侧后。当 BI≥95 作为时变协变量添加到模型中时，这种下降仍然存在，且功能状态也预测 QLI。随着时间的推移，QLI 的变化因保险状况而异（交互作用 p 值=0.0017），有 Medicaid/无保险者下降（p<0.0001），而 Medicare/私人保险者无变化（p=0.98）。
在这项基于人群的研究中，在无复发或 MI 的幸存者中，卒中后 QOL 每年下降，持续 5 年，且独立于其他危险因素。Medicaid 患者的 QLI 下降更为明显，与年龄、情绪、卒中严重程度、尿失禁、功能状态、认知和卒中侧有关。
