Changes in Life Expectancy After Stroke Among Americans Aged 50 and Above by Sex, 1996-2018

Stroke remains a leading cause of mortality and disability in the United States. As the population ages, understanding trends in survival among stroke survivors is critical for healthcare planning and evaluating secondary prevention efforts.

Using longitudinal data from the nationally representative Health and Retirement Study (1996-2018; 39,084 individuals, 225,316 person-wave observations), in which stroke status is self-reported, we computed life expectancy at Age 50 (LE50) for those with and without a previous stroke history using discrete-time multistate models (a Markov chain approach for panel data). Estimates were stratified by sex and compared across two 10-year periods (1996-2006 vs. 2008-2018), with 95% confidence intervals obtained from 1000 bootstrap iterations. Cox proportional hazards models with progressively expanded covariate sets (sociodemographics, heart disease, BMI, insurance type, race/ethnicity) were fitted as exploratory analyses to assess the robustness of stroke-mortality associations to potential confounding.

LE50 among individuals with a self-reported previous stroke history at baseline increased by 3.1 years (95% CI: 1.7-4.4) between 1996-2006 and 2008-2018 for both sexes combined, with men gaining 3.4 years (2.0-4.8) and women 2.5 years (0.8-4.3). Gains exceeded those in the general population (1.1 years, 0.6-1.6). Point estimates suggested somewhat larger gains among men, though confidence intervals overlapped and a statistically significant sex difference could not be confirmed. For first-time incident strokes during the observation period, post-stroke survival showed no statistically significant change across periods.

Long-term consequences of stroke appear to be becoming less lethal, likely reflecting improvements in secondary prevention and post-stroke long-term care. Nonetheless, a gap of approximately 10 years in LE50 between stroke survivors and the general population persisted in 2008-2018. Continued investment in both acute stroke care and long-term secondary prevention remains essential to further close this gap.