Male stroke patients who live alone are at greater risk of premature death

Men who live alone have a considerably greater long-term risk of dying prematurely than other patients. This is shown in a doctoral thesis that followed 1,090 stroke cases in western Sweden.

As part of the Sahlgrenska Academy Study on Ischemic Stroke (SAHLSIS), Petra Redfors examined the long-term prognosis for 1,090 victims of ischemic stroke before the age of 70 and compared the results with 600 controls.

Excess mortality
According to her findings, 36% of patients who were living alone, as opposed to 17% of those with partners, died within 12 years after stroke. Among men, the gap widened to 44% vs. 14%.

Excess mortality associated with living alone was still found after adjusting for physical inactivity, high alcohol consumption, low educational level and other known risk factors.

"Among the conceivable causes are that people who live alone lead less healthy lives, are less prone to take their medication and tend to wait longer before going to the emergency room," Dr. Redfors says. "For the healthy controls, excess mortality was also greater among men, particularly those living alone."

Multiple risk
Etiology played a key role as well— having had a stroke due to large vessel disease, a blood clot from the heart or diabetes was an additional risk factor.

The thesis demonstrates that stroke victims faced 10 times as great a risk of recurrence within 12 years as healthy controls. The risk of myocardial infarction was twice as much.

"The pattern of excess mortality among people who live alone showed up here as well," Dr. Redfors says. "Among the other risk factors for recurrence were the severity of the original event, along with diabetes or coronary artery disease. Physical inactivity increased the risk of cardiac infarction after stroke."

Long-term cognitive loss
The thesis also found that a large percentage of stroke victims were still experiencing memory, concentration, cognitive and other loss at 7-year follow-up. Because many of them are of working age, the personal and social impact is enormous.

"Our results underscore the importance of intensive, long-term prevention among stroke patients, including medication for hypertension, diabetes and other underlying conditions, along with lifestyle changes," Dr. Redfors says. "Above all, serious consideration needs to be given to providing greater support and more thorough information for patients who are living alone."

The thesis Long-term Post-stroke Outcome - the Sahlgrenska Academy Study on Ischemic Stroke was defended on November 28.