TY - JOUR
T1 - Diabetes predicts long-term disability in an elderly urban cohort
T2 - The Northern Manhattan Study
AU - Dhamoon, Mandip S.
AU - Moon, Yeseon Park
AU - Paik, Myunghee C.
AU - Sacco, Ralph L.
AU - Elkind, Mitchell S.V.
N1 - Funding Information:
This work was supported by grants from the National Institute of Neurological Disorders and Stroke ( R01 NS48134 to M.S.V.E.; R37 29993 to R.L.S. and M.S.V.E.; K23NS079422 to M.S.D.).
PY - 2014/5
Y1 - 2014/5
N2 - Purpose: There are limited data on vascular predictors of long-term disability in Hispanics. We hypothesized that (1) functional status declines over time and (2) vascular risk factors predict functional decline. Methods: The Northern Manhattan Study contains a population-based study of 3298 stroke-free individuals aged 40 years or older, followed for median 11 years. The Barthel Index (BI) was assessed annually. Generalized estimating equations and Cox models were adjusted for demographic, medical, and social risk factors. Stroke and myocardial infarction occurring during follow-up were censored in sensitivity analysis. Secondarily, motor and nonmotor domains of the BI were analyzed. Results: Mean age (standard deviation) of the cohort (n = 3298) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% diabetic, and 74% hypertensive. There was a mean annual decline of 1.02 BI points (P < .0001). Predictors of decline in BI included age, female sex, diabetes, depression, and normocholesterolemia. Results did not change with censoring. We found similar predictors of BI for motor and nonmotor domains. Conclusion: In this large, population-based, multiethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when vascular events were censored. Diabetes predicted functional decline in the absence of clinical vascular events.
AB - Purpose: There are limited data on vascular predictors of long-term disability in Hispanics. We hypothesized that (1) functional status declines over time and (2) vascular risk factors predict functional decline. Methods: The Northern Manhattan Study contains a population-based study of 3298 stroke-free individuals aged 40 years or older, followed for median 11 years. The Barthel Index (BI) was assessed annually. Generalized estimating equations and Cox models were adjusted for demographic, medical, and social risk factors. Stroke and myocardial infarction occurring during follow-up were censored in sensitivity analysis. Secondarily, motor and nonmotor domains of the BI were analyzed. Results: Mean age (standard deviation) of the cohort (n = 3298) was 69.2 (10) years, 37% were male, 52% Hispanic, 22% diabetic, and 74% hypertensive. There was a mean annual decline of 1.02 BI points (P < .0001). Predictors of decline in BI included age, female sex, diabetes, depression, and normocholesterolemia. Results did not change with censoring. We found similar predictors of BI for motor and nonmotor domains. Conclusion: In this large, population-based, multiethnic study with long-term follow-up, we found a 1% mean decline in function per year that did not change when vascular events were censored. Diabetes predicted functional decline in the absence of clinical vascular events.
KW - Disability
KW - Epidemiology
KW - Stroke
UR - http://www.scopus.com/inward/record.url?scp=84899970277&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2013.12.013
DO - 10.1016/j.annepidem.2013.12.013
M3 - Article
C2 - 24485410
AN - SCOPUS:84899970277
SN - 1047-2797
VL - 24
SP - 362-368.e1
JO - Annals of Epidemiology
JF - Annals of Epidemiology
IS - 5
ER -