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Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)
Department of Neurology, School of Medical Sciences, Örebro University, Örebro, Sweden.ORCID iD: 0000-0001-6504-9049
Örebro University, School of Medical Sciences. (Clinical Epidemiology and Biostatistics)ORCID iD: 0000-0002-3649-2639
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2016 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 47, no 9, p. 2416-2418Article in journal (Refereed) Published
Abstract [en]

Background and purpose: Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke.

Methods: Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first.

Results: Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45).

Conclusions: Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors.

Place, publisher, year, edition, pages
Philadelphia, USA: Lippincott Williams & Wilkins, 2016. Vol. 47, no 9, p. 2416-2418
Keywords [en]
Adolescent, blood pressure, length of stay, psychological stress, risk factors
National Category
Cardiac and Cardiovascular Systems Neurology
Identifiers
URN: urn:nbn:se:oru:diva-51591DOI: 10.1161/STROKEAHA.116.014265ISI: 000383559300052PubMedID: 27491740Scopus ID: 2-s2.0-84982813061OAI: oai:DiVA.org:oru-51591DiVA, id: diva2:951225
Note

Funding Agencies:

UK Economic and Social Research Council RES-596-28-0001  ES/JO19119/1

Stiftelsen Olle Engqvist Byggmästare

Folksam

Örebro University

Available from: 2016-08-08 Created: 2016-08-08 Last updated: 2018-07-20Bibliographically approved
In thesis
1. Life-course influences on occurrence and outcome for stroke and coronary heart disease
Open this publication in new window or tab >>Life-course influences on occurrence and outcome for stroke and coronary heart disease
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Although typical clinical onset does not occur until adulthood, cardiovascular disease (CVD) may have a long natural history with accumulation of risks beginning in early life and continuing through childhood and into adolescence and adulthood. Therefore, it is important to adopt a life-course approach to explore accumulation of risks, as well as identifying age-defined windows of susceptibility, from early life to disease onset. This thesis examines characteristics in adolescence and adulthood linked with subsequent risk of CVD. One area is concerned with physical and psychological characteristics in adolescence, which reflects inherited and acquired elements from childhood, and their association with occurrence and outcome of subsequent stroke and coronary heart disease many years later. The second area focuses on severe infections and subsequent delayed risk of CVD. Data from several Swedish registers were used to provide information on a general population-based cohort of men. Some 284 198 males, born in Sweden from 1952 to 1956 and included in the Swedish Military Conscription Register, form the basis of the study cohort for this thesis. Our results indicate that characteristics already present in adolescence may have an important role in determining long-term cardiovascular health. Stress resilience in adolescence was associated with an increased risk of stroke and CHD, working in part through other CVD factors, in particular physical fitness. Stress resilience, unhealthy BMI and elevated blood pressure in adolescence were also associated with aspects of stroke severity among survivors of a first stroke. We demonstrated an association for severe infections (hospital admission for sepsis and pneumonia) in adulthood with subsequent delayed risk of CVD, independent of risk factors from adolescence. Persistent systemic inflammatory activity which could follow infection, and that might persist long after infections resolve, represents a possible mechanism. Interventions to protect against CVD should begin by adolescence; and there may be a period of heightened susceptibility in the years following severe infection when additional monitoring and interventions for CVD may be of value.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 156
Keywords
cardiovascular disease, stroke, risk factors, adolescence, stress resilience, adult infections, life-course epidemiology, cohort study
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-54254 (URN)978-91-7529-177-2 (ISBN)
Public defence
2017-03-10, Örebro universitet, Campus USÖ, hörsal C3, Södra Grev Rosengatan 32, Örebro, 09:30 (Swedish)
Opponent
Supervisors
Available from: 2017-01-03 Created: 2017-01-03 Last updated: 2018-01-13Bibliographically approved

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Bergh, CeciliaUdumyan, RuzanAppelros, PeterFall, KatjaMontgomery, Scott

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