Functional Status Declines Over Time After First Stroke
Decline independent of stroke severity; seen especially in Medicaid and uninsured groups
27 june 2009-- In the five years following a first stroke, patients have modest declines in functional status, which are more noticeable in those with Medicaid or who are uninsured, according to research published online June 25 in Stroke.
Mandip S. Dhamoon, M.D., of Columbia University in New York City, and colleagues analyzed data from 525 survivors of a first ischemic stroke, all at least 40 years of age. The researchers evaluated subjects at six months and annually for five years, assessing functional status with the Barthel Index, terming it favorable or unfavorable based on the score. Follow-up was censored at death, a recurrent stroke or a heart attack.
The researchers found that the proportion of patients with favorable functional status declined annually after adjusting for demographics, risk factors, and stroke characteristics (odds ratio per year after stroke, 0.91). The functional status of those with Medicaid or no insurance declined, but the status of those with Medicare or private insurance did not.
"Functional decline in our study was seen particularly among those who were uninsured or insured with Medicaid. This decline began to be apparent at approximately three years," the authors write. "Over time after stroke, however, functional status among those with private insurance and Medicare and those with Medicaid or no insurance may diverge due to disparities in care and more limited access to rehabilitative services, information about health, and ongoing management of risk factors and chronic conditions that are known to have an impact on functional status."