Stroke and active life expectancy in the United States, 1999-2009

Stroke reduces active life expectancy, both years lived and their proportion without disability. However, active life expectancy studies have provided limited information about strokes in the United States, those occurring throughout older life, or those affecting African Americans.

To measure associations between strokes throughout older life and active life expectancy for African American and White women and men.

Using data from the Panel Study of Income Dynamics, 1999-2009 (n = 1862, 13,603 person-years), we estimated monthly probabilities of death and disability in activities of daily living with multinomial logistic Markov models adjusted for age, sex, ethnicity, stroke in the past two years, earlier stroke, and education. A random effect accounted for the panel data repeated measures. Microsimulation created large populations with stroke incidence throughout older life, identifying life expectancy and the proportions of remaining life with and without disability. We matched individuals with strokes with randomly selected persons without strokes by age at first stroke, sex, ethnicity, and previous disability.

Average age at first stroke was higher for women, lower for African Americans. African American and White women were disabled for about two-thirds of life after stroke; results for men were 61.8% for African Americans and 37.2% for Whites. Compared to matched participants, those with strokes lived 33% fewer remaining years (95% confidence interval, CI 30.9%-34.7%) with a 31.6% greater proportion of remaining life with disability (CI 14.4%-55.6%).

Stroke greatly reduces both life expectancy and the proportion of life without disability, particularly for women and African Americans.