Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis

Jiang, Xiaohui; Morgenstern, Lewis B.; Cigolle, Christine T.; Claflin, E. S.; Lisabeth, Lynda D.

doi:10.1159/000503900

Cited by 17 publications

(16 citation statements)

References 47 publications

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“…In our study, MCDs status was found to be a risk factor for functional disability. Studies focusing on elderly stroke patients were limited, and we found some similar findings in a population with a single condition (geriatric or stroke) [39]. A recent systematic review of 3339 stroke patients from seven hospital-based cohort studies, indicated that MCDs were longitudinally associated with an 11 % increase in the risk of functional disability after stroke, irrespective of the different methods used for assessing MCDs and functional disability [39].…”

Section: Discussionsupporting

confidence: 62%

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

Liu

Gao

et al. 2021

BMC Geriatr

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Background Multiple chronic diseases (MCDs) and social isolation are independent risk factors related to stroke and disability, but it is unknown whether the combination of these two conditions resulted from aging-related to functional disability in stroke patients. This study aimed to probe the relationship between the combination of MCDs, social isolation, and functional disability after stroke in elderly patients. Methods A multicenter and cross-sectional study was conducted in the Departments of Rehabilitation of 103 hospitals located in 23 cities across China. Stroke patients aged 60–90 years were selected for analysis. Demographic characteristics, lifestyles, and clinical information were investigated by questionnaires and medical records. MCDs (hypertension/ diabetes/ hyperlipidemia/heart disease/kidney disease) were categorized into three levels: 0, 1, and ≥ 2. Functional disability was assessed by the Barthel Index and categorized into four groups: no, mild, moderate, and severe disability. The multi-nominal logistic regression model was used to explore the independent and combined association of MCDs and social isolation with functional disability. Results A total of 4046 elderly stroke patients (55 % males) were included in the final analysis. The prevalence of social isolation, MCDs ≥ 2, and severe disability increased with aging. In the fully adjusted model, patients with social isolation or MCDs had a higher risk of functional disability significantly than those without. Patients with social isolation combined MCDs ≥ 2 were 35 times (95 % CI: 18.89–64.69) more likely to suffer severe disability after stroke, and 8 times (95 % CI: 18.89–64.69) for moderate disability than those without social isolation and MCDs. Conclusions MCDs, social isolation, and their combination were associated with a higher risk of functional disability after stroke in Chinese elderly patients. The elderly population should be encouraged to participate in more social activities, particularly in those with MCDs. Future secondary prevention and rehabilitation treatments to the functional ability of elderly stroke patients should underscore both social activity and the combined treatments of MCDs. Trial registration NO: ChiCTR2000034067.

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Section: Discussionsupporting

confidence: 62%

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

Liu

Gao

et al. 2021

BMC Geriatr

View full text Add to dashboard Cite

show abstract

“…Studies focusing on elderly stroke patients were limited, and we found some similar ndings in a population with a single condition (geriatric or stroke) [37]. A recent systematic review of 3339 stroke patients from seven hospital-based cohort studies, indicated that MCDs are longitudinally associated with an 11% increase in the risk of functional disability after stroke, irrespective of the different methods used for assessing MCDs and functional disability [37]. Meanwhile, a large cohort study including a general geriatric population also showed that MCDs signi cantly increased the risk of functional disability by 117% [38].…”

Section: Discussionsupporting

confidence: 54%

“…In our study, MCD status was found to be a risk factor for functional disability. Studies focusing on elderly stroke patients were limited, and we found some similar ndings in a population with a single condition (geriatric or stroke) [37]. A recent systematic review of 3339 stroke patients from seven hospital-based cohort studies, indicated that MCDs are longitudinally associated with an 11% increase in the risk of functional disability after stroke, irrespective of the different methods used for assessing MCDs and functional disability [37].…”

Section: Discussionmentioning

confidence: 51%

Combined Association of Multiple Chronic Diseases and Social Isolation With Functional Disability in Elderly Stroke Patients: A Multicentre Cross-sectional Study in China

Liu¹,

Yu²,

Gao³

et al. 2021

Preprint

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BackgroundMultiple chronic diseases (MCDs) and social isolation are independent risk factors related with stroke and disability, but it is unknown whether the combination of these two conditions resulted from ageing related to functional disability in stroke patients. The purpose of this study was to probe the relationship between combination of MCDs, social isolation and functional disability in elderly stroke patients.MethodsA multicentre and cross-sectional study was conducted in the Departments of Rehabilitation Medicine of 103 hospitals located in 23 cities across China. Stroke patients aged over 60 years were selected as participants. Demographic characteristics, lifestyles and clinical information were investigated by questionnaire and medical records. Multi-nominal logistic regression model was used to explore the association of MCDs, social isolation and their combination with functional disability assessed by Barthel Index Scale.ResultsA total of 4281 elderly stroke patients were included in the final analysis. The proportion of social isolation and MCDs (>1) increased by the severity of functional disability. Social isolation was associated with increased risks for mild (33%), moderate (175%), and severe (833%) functional disability significantly in their comparisons with those without social isolation and MCDs. The intragroup odds ratio (OR) of MCDs increased by its number and the intergroup of OR increased by the severity of functional disability significantly. Social isolation and ≥3 MCDs associated the highest risk for severe (OR= 38.24, 95%CI: 14.76-99.07) and moderate (OR = 9.74, 95%CI: 3.62-26.22) functional disability, but not significant for mild group.ConclusionsMCDs, social isolation, and their combination were associated with functional disability in Chinese elderly stroke patients. Future secondary prevention and rehabilitation for functional disability in this population should underscore both social activity and the combined treatments of MCDs.Clinical Trial Registration NOChiCTR2000034067.

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“…Previous studies focused predominantly on the prevalence, health care utilization, and health-associated outcomes of multimorbidity among older adults (19)(20)(21)(22). As findings from a study done in China suggest, multimorbidity is more prevalent among the rural population (58.3%) than among their urban counterparts (50.4%) (23).…”

Section: Introductionmentioning

confidence: 99%

Urban–Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

Zhang

Xiao

Shi

et al. 2021

Front. Public Health

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Introduction: Multimorbidity has become one of the key issues in the public health sector. This study aimed to explore the urban–rural differences in patterns and associated factors of multimorbidity in China and to provide scientific reference for the development of health management strategies to reduce health inequality between urban and rural areas.Methods: A cross-sectional study, which used a multi-stage random sampling method, was conducted effectively among 3,250 participants in the Shanxi province of China. The chi-square test was used to compare the prevalence of chronic diseases among older adults with different demographic characteristics. The Apriori algorithm and multinomial logistic regression were used to explore the patterns and associated factors of multimorbidity among older adults, respectively.Results: The findings showed that 30.3% of older adults reported multimorbidity, with significantly higher proportions in rural areas. Among urban older adults, 10 binary chronic disease combinations with strong association strength were obtained. In addition, 11 binary chronic disease combinations and three ternary chronic disease combinations with strong association strength were obtained among rural older adults. In rural and urban areas, there is a large gap in patterns and factors associated with multimorbidity.Conclusions: Multimorbidity was prevalent among older adults, which patterns mainly consisted of two or three chronic diseases. The patterns and associated factors of multimorbidity varied from urban to rural regions. Expanding the study of urban–rural differences in multimorbidity will help the country formulate more reasonable public health policies to maximize the benefits of medical services for all.

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Multiple Chronic Conditions and Functional Outcome after Ischemic Stroke: A Systematic Review and Meta-Analysis

Cited by 17 publications

References 47 publications

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

Combined association of multiple chronic diseases and social isolation with the functional disability after stroke in elderly patients: a multicenter cross-sectional study in China

Combined Association of Multiple Chronic Diseases and Social Isolation With Functional Disability in Elderly Stroke Patients: A Multicentre Cross-sectional Study in China

Urban–Rural Differences in Patterns and Associated Factors of Multimorbidity Among Older Adults in China: A Cross-Sectional Study Based on Apriori Algorithm and Multinomial Logistic Regression

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