Abstract P213: Does Smoking Impact Rates of Decline in Functional Independence Before and After Stroke?
Introduction: Although smoking is considered a risk factor for stroke and Activities of Daily Living (ADL) limitations, it is not known whether smoking predicts faster declines in ADL limitations among stroke patients, or whether the association between smoking and functional decline is of greater magnitude in stroke patients than among stroke-free individuals.
Hypothesis: We hypothesized that smoking at baseline predicts faster ADL declines among both those who remain stroke free and those who have stroke, and this effect is larger for stroke survivors.
Methods: Health and Retirement Study participants (n=18,365) or proxies reported biennially (1998-2010) on stroke status and 5 basic ADL limitations. Using pooled logistic regressions, we compared ADL trajectories by baseline smoking status for those who remained stroke-free (n=16459) and those who survived stroke (n=1450) during follow-up.
Results: Among those who remained stroke-free, most non-smokers were fully independent (e.g., 79.0% at age 75), and 1.2% of previously independent individuals developed an ADL limitation each year. Among the stroke-free, smokers were less likely to be independent (76.0% at age 75) but lost independence more slowly over follow-up (0.9% per year, p=0.002). Among those who survived stroke, smokers had lower baseline function (i.e., prior to stroke: 71.4% were independent at age 75 compared to 74.7% of non-smokers), but not faster declines prior to stroke (3.3% vs 2.8%per year), at the time of stroke (6.1% vs 16.3%) or after stroke (1.5% vs 2.8% per year) (See figure).
Conclusions: Smoking was associated with lower levels of ADL independence in both stroke-free and stroke survivors, but not faster rates of decline.
- © 2013 by American Heart Association, Inc.