Determinants of Health Status After Stroke: A Cohort Study with Repeated Measurements

Figures & data

Figure 1 Selection of participants in a cohort of patients for Region Central Denmark suffering first time stroke between October 2008 and January 2012.

Table 1 Attrition and Response Pattern in a Cohort of Danish First-Time Stroke Patients Alive 90 Days After (N=3,221)

		Months Since Stroke
		3 months	6 months	12 months	18 months	24 months
Cumulative absolute cohort mortality		90	134	185	237	297
Alive in current round		97.2%	95.8%	94.3%	92.6%	90.8%
Send out questionnaires		3,221	2,405	2,196	1,907	1,652
Drop-out		807^a	198	280	248	211
Attrition		25.1%	8.2%	12.8%	13.0%	12.8%
Active participants		2,414	2,207	1,915	1,659	1,441
Dead^b		9	11	9	7	n/a
Available for next round		2,405	2,196	1,907	1,652	n/a
Intermittent missing		894	529	403	370	301
Returned questionnaires		1,520	1,678	1,513	1,289	1,140

Notes: ^a9.9% of these patients were alive at 3 months, but died before answering the first questionnaire. ^bPatients who answered the questionnaire in the current round, but died before entering the next round.

Table 2 Patient Characteristics of Respondents in a Cohort of Danish Stroke Patients (N=2,414)

		n	(%)
Gender
	Female	941	(39%)
	Male	1,473	(61%)
Age
	18–59	652	(27%)
	60–69	845	(35%)
	70–79	917	(38%)
Marital status
	Married/cohabiting	1,738	(72%)
	Single	652	(27%)
	Missing	24	(1%)
Education
	Low (<11 years)	676	(28%)
	Medium (11–14 years)	1,062	(44%)
	High (15+ years)	435	(18%)
	Missing	241	(10%)
Comorbidity
	Charlson Index 0	1,400	(58%)
	Charlson Index 1–2	966	(40%)
	Charlson Index 3+	48	(2%)
Stroke severity
	Mild	1,642	(68%)
	Moderate	362	(15%)
	Severe/very severe	241	(10%)
	Missing	169	(7%)
Type of stroke
	Ischemic	2,101	(87%)
	Intracerebral hemorrhage	216	(9%)
	Unspecified	72	(3%)
	Missing	0	(0%)
Smoking
	Current	917	(38%)
	Former	652	(27%)
	Never	724	(30%)
	Missing	121	(5%)
Alcohol
	<14/21 drinks per week	2,052	(85%)
	14/21+ drinks per week	240	(10%)
	Missing	122	(5%)
Body Mass Index
	<25 kg/m^2	748	(31%)
	25–29 kg/m^2	893	(37%)
	30+ kg/m^2	483	(20%)
	Missing	290	(12%)

Figure 2 Measurements of Short-Form 12 physical and mental component scores in a cohort of 2,414 Danish first time stroke patients. Lowess smoothing curve bandwidth=0.8.

Table 3 Differences in SF-12 Mental Component Summary (MCS) at Each Point of Follow-Up in a Cohort of 2414 First-Time Danish Stroke Patients

	Months Since Stroke
	3		6		12		18		24
	Mean	Difference^a	Mean	Difference^a	Mean	Difference^a	Mean	Difference^a	Mean	Difference^a
Crude MCS score	45.7		46.7		46.8		47.1		47.7
Gender
Female	43.6	Ref	45.2	Ref	45.2	Ref	45.5	Ref	46.4	Ref
Male	47.0	3.2 ***	47.6	2.1 ***	47.9	2.3 ***	48.2	2.3 ***	48.6	1.9 **
Age
18–59	43.4	Ref	44.6	Ref	44.9	Ref	46.0	Ref	46.1	Ref
60–69	46.7	3.7 ***	47.7	3.4 ***	47.8	3.3 ***	48.0	2.6 ***	48.5	2.8 ***
70–79	46.5	4.3 ***	47.3	3.7 ***	47.2	3.5 ***	47.1	2.4 **	48.3	3.3 ***
Educational level
Low (<11 years)	45.0	Ref	45.6	Ref	45.9	Ref	45.8	Ref	46.9	Ref
Medium (11–14 years)	45.5	0.4	46.7	1.0	46.6	0.6	47.1	1.1	47.7	0.8
High (14+ years)	47.0	1.6	48.3	2.3 **	48.6	2.3 **	49.2	2.9 ***	49.2	2.0 *
Type of stroke
Ischemic	46.0	Ref	46.9	Ref	46.9	Ref	47.3	Ref	47.9	Ref
Intracerebral hemorrhage	42.6	−2.6 *	45.5	−0.6	45.3	−0.8	45.5	−1.0	46.3	−0.7
Unspecified	46.4	0.1	44.6	−2.7 *	47.9	0.6	47.1	−0.4	47.4	−0.7
Comorbidity
Charlson Index 0	46.6	Ref	47.3	Ref	47.7	Ref	48.4	Ref	48.7	Ref
Charlson Index 1–2	45.2	−1.8 **	46.4	−1.3 *	46.2	−1.9 ***	46.1	−2.5 ***	46.7	−2.3 ***
Charlson Index 3+	43.0	−5.0 ***	44.9	−3.4 ***	45.0	−4.2 ***	44.6	−5.6 ***	47.0	−3.7 **
Stroke severity
Mild	46.4	Ref	47.4	Ref	47.6	Ref	47.9	Ref	48.5	Ref
Moderate	44.6	−1.4	45.5	−1.7 *	45.4	−1.8 **	45.8	−1.7 *	46.3	−1.9 *
Severe/very severe	42.8	−2.8 *	43.6	−3.5 ***	43.8	−3.3 ***	44.1	−3.2 **	45.	−3.0 **

Notes: ^aThe differences in scores between levels of categories. Differences were mutually adjusted for all covariates. *P<0.05; **P<0.01; ***P<0.001. 95% CI are displayed in Supplementary Table II.

Table 4 Differences in SF-12 Physical Component Summary (PCS) at Each Point of Follow-Up in a Cohort of 2414 First-Time Danish Stroke Patients

	Months Since Stroke
	3		6		12		18		24
	Mean	Difference^a	Mean	Difference^a	Mean	Difference^a	Mean	Difference^a	Mean	Difference^a
Unadjusted PCS score	41.6		41.9		42.1		42.1		42
Gender
Female	40.7	Ref	40.6	Ref	40.3	Ref	40.4	Ref	40.2	Ref
Male	42.2	0.6	42.7	1.3 **	43.2	2.1 ***	43.3	2.0 ***	43.1	2.0 ***
Age
18–59	43.2	Ref	44.0	Ref	44.5	Ref	44.5	Ref	44.8	Ref
60–69	42.4	−0.1	42.7	−0.5	42.8	−1.1	43.1	−0.7	42.7	−1.5 *
70–79	39.8	−1.6 *	39.6	−2.6 ***	39.7	−3.2 ***	39.5	−3.3 ***	39.1	−4.2 ***
Educational level
Low (<11 years)	39.3	Ref	39.7	Ref	39.9	Ref	39.8	Ref	39.5	Ref
Medium (11–14 years)	41.9	2.2 ***	42.1	2.0 ***	42.3	1.8 **	42.4	2.0 **	42.2	2.1 ***
High (15+ years)	44.5	4.2 ***	44.9	4.0 ***	44.9	3.7 ***	45.2	4.1 ***	45.1	4.4 ***
Type of stroke
Ischemic	41.8	Ref	42.0	Ref	42.2	Ref	42.3	Ref	42.1	Ref
Intracerebral hemorrhage	39.9	−0.1	40.1	−0.5	40.7	−0.2	41.1	0.2	40.4	−0.4
Unspecified	41.7	−0.4	42.5	0.3	42.2	−0.4	41.6	−0.8	42.5	0.2
Comorbidity
Charlson Index 0	43.4	Ref	43.8	Ref	43.8	Ref	44.0	Ref	43.7	Ref
Charlson Index 1–2	40.4	−2.4 ***	40.5	−2.6 ***	40.7	−2.3 ***	40.5	−2.7 ***	40.5	−2.2 ***
Charlson Index 3+	35.8	−6.3 ***	35.6	−6.9 ***	37.6	−5.9 ***	37.6	−6.2 ***	37.6	−5.3 ***
Stroke severity
Mild	43.5	Ref	43.6	Ref	43.6	Ref	43.6	Ref	43.5	Ref
Moderate	38.2	−4.6 *	38.8	−3,9 ***	39.2	−3,5 ***	39.5	−3,2 ***	39.1	−3,5 ***
Severe/very severe	34.6	−8.5 ***	35.7	−7.3 ***	36.6	−6.5 ***	36.5	−6.5 ***	36.6	−6.2 ***

Notes: ^aThe differences in scores between levels of categories. Differences were mutually adjusted for all covariates. *P<0.05; **P<0.01; ***P<0.001. 95% CI are displayed in Supplementary Table III.

Table 5 Determinants of Courses of SF-12 Mental and Physical Component Summary (MCS/PCS) in a Cohort of 1613 Danish Stroke Patients

	MCS		PCS
	Difference^a	Time dependence^b	Difference^a	Time dependence^b
Gender
Female	Ref	Ref	Ref	Ref
Male	3.0 ***	−0.03	1.4 *	0.04
Age, years
18–59	Ref	Ref	Ref	Ref
60–69	3.6 ***	−0.04	−0.2	−0.02
70–79	4.0 ***	−0.08 *	−1.9 **	−0.09 **
Educational level
Low (<11 years)	Ref	Ref	Ref	Ref
Medium (11–14 years)	0.5	0.01	2.0 **	−0.01
High (14+ years)	1.8 *	0.03	3.8 ***	0.01
Type of stroke
Ischemic	Ref	Ref	Ref	Ref
Intracerebral hemorrhage	−1.3	0.01	−1.0	0.03
Unspecified	−3.2	0.13	1.3	−0.05
Comorbidity
Charlson Index 0	Ref	Ref	Ref	Ref
Charlson Index 1–2	−0.6	−0.07 *	−2.1 ***	−0.01
Charlson Index 3+	−3.5 ***	−0.02	−6.0 ***	−0.01
Stroke severity
Mild	Ref	Ref	Ref	Ref
Moderate	−1.3	−0.06	−4.5 ***	0.07
Severe/very severe	−2.2 *	−0.08	−7.8 ***	0.12 *

Notes: *P<0.05; **P<0.01; ***P<0.001. ^aThe differences in scores between levels of categories. Differences were mutually adjusted for all covariates. ^bInteraction term between levels of the covariate and time 95% CI are displayed in Supplementary Table IV.

Table 6 Unadjusted Means (95% CI) of SF-12 Subscales at Each Time Point of Follow-Up in a Cohort of 2414 Danish First-Time Stroke Patients

Months Since Stroke	Physical Functioning (PF)	Role Physical (RP)	Bodily Pain (BP)	General Health (GH)	Vitality (VT)	Social Function (SF)	Role Emotional (RE)	Mental Health (MH)
3	58.2 (56.6–59.7)	51.6 (50.1–53.1)	68.1 (66.5–69.7)	53.2 (51.8–54.3)	40.6 (39.0–41.8)	73.9 (72.2–75.5)	61.8 (60.2–63.4)	66.0 (64.9–67.0)
6	59.4 (57.2–60.9)	54.0 (52.6–55.4)	68.8 (67.4–70.2)	54.2 (53.1–55.4)	42.6 (41.3–43.9)	75.9 (74.6–77.3)	65.0 (63.7–66.4)	67.0 (66.0–68.0)
12	59.1 (57.8–61.0)	55.5 (54.0–57.0)	69.1 (67.6–70.5)	55.3 (54.2–56.4)	42.7 (41.4–44.0)	76.2 (74.9–77.5)	64.7 (63.3–66.2)	68.0 (67.0–69.1)
18	59.4 (57.7–61.1)	56.3 (54.8–57.7)	69.0 (67.4–70.6)	54.7 (53.6–55.9)	44.6 (43.1–46.1)	75.5 (74.1–76.9)	65.2 (63.7–66.7)	68.5 (67.6–69.5)
24	58.7 (56.9–60.4)	56.1 (54.4–57.6)	69.7 (68.2–71.3)	56.2 (55.0–57.5)	44.5 (43.0–46.0)	77.9 (76.4–79.5)	65.6 (64.0–67.2)	69.1 (67.9–70.3)
Increase per year	−0.1 (−1.2;0.9) P=0.81	2.1 (1.1;3.2) P<0.0001	0.6 (−0.5;1.6) P=0.29	1.3 (0.5;2.1) P<0.01	2.1 (1.1;3.1) P<0.0001	1.5 (0.6;2.5) P<0.01	1.5 (0.7;2.2) P<0.001	1.7 (0.9;2.5) P<0.001