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      Health-related quality of life and related factors in stroke survivors: Data from Korea National Health and Nutrition Examination Survey (KNHANES) 2008 to 2014

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          Abstract

          As persons with stroke are surviving longer, monitoring and managing their quality of life is becoming important. We reviewed the Korea National Health and Nutrition Examination Survey (KNHANES) in order to evaluate the health-related quality of life (HRQoL) in stroke survivors as measured by the Euro Quality of Life-5D (EQ-5D), and to find out influencing factors. A total of 42,500 subjects were enrolled in the KNHANES, and 575 of them were persons with stroke. The EQ-5D index was lower in persons with stroke than those without stroke, when adjusted for age and sex (with stroke: 0.757±0.012, without stroke: 0.948±0.001, p < .0001). Dimension-specific influencing factors of HRQoL were observed in persons with stroke; mobility problems increased with old age; self-care problems increased with old age and depression; usual activity problems increased with old age, low income, absence of economic activity, and depression; pain/discomfort problems increased with low income. The EQ-5D index was lower in stroke survivors with older age, hypertension, diabetes mellitus, and lack of regular exercise. This is the first study to utilize nationally representative data of the Korean population to investigate the effect of stroke on HRQoL and explore the dimension-specific influencing factors. Further development of rehabilitative interventions for post-stroke depression, vocational rehabilitation, and tailored programs for encouraging physical activity may be needed to improve the HRQoL in Korean stroke survivors.

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          The influence of gender and age on disability following ischemic stroke: the Framingham study.

          Margaret Kelly-Hayes, Alexa S Beiser, Carlos Kase … (2007)
          The magnitude of disability among elderly stroke survivors is substantial. There have been few community-based estimates of the contribution gender and older age make to stroke-related disability and outcome. Using the original Framingham Study cohort, we documented gender-specific neurological deficits and disability differences in stroke survivors at six months post-stroke. Logistic regression analyses were performed to estimate odds ratios, comparing men and women, and adjusting for age, and age and stroke subtype. Age and gender-matched controls were then compared to distinguish stroke-related disability from disability associated with general aging. Results showed that almost half (43%) of all elderly stroke survivors in the cohort had moderate to severe neurological deficits. In the crude analyses, women were more dependent in ADLs (33.9% vs 15.6%), less likely to walk unassisted (40.3% vs 17.8%), and living in nursing homes (34.9 % vs 13.3%). After adjusting for age and stroke subtype, it was older age that accounted for the severity of disability. When compared to age and gender-matched controls, stroke cases were significantly more disabled in all domains studied. In this elderly cohort, more women experienced initial strokes and were more disabled at 6 months post-stroke than men. However, older age at stroke onset, not gender or stroke subtype, was associated with greater disability. Health care providers need to understand that strokes occur later in life for women and that because of age, women are at greater risk for disability and institutionalization.
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            Factors influencing stroke survivors' quality of life during subacute recovery.

            Deborah Nichols-Larsen, P. Clark, Angelique Zeringue … (2005)
            Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery. Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains. Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity motor function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer HRQOL in the physical domain was associated with age, nonwhite race, more comorbidities, and reduced upper-extremity function. Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking, and those with an ischemic stroke and concordance reported poorer communication. Although results may not generalize to lower functioning stroke survivors, individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive, targeted interventions designed to maximize recovery and improve HRQOL.
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              Obesity and Metabolic Syndrome in Korea

              Sang Oh (2011)
              In Korea, a person with a body mass index (BMI) ≥25 kg/m2 is considered obese, and a person with a BMI ≥30 kg/m2 is classified as severely obese. Central obesity is defined as a waist circumference ≥90 cm for Korean men and ≥85 cm for Korean women. Recent epidemiologic data show that the prevalence of severe obesity and metabolic syndrome is steadily increasing. These epidemics increased morbidity and mortality of type 2 diabetes, cardiovascular diseases, and obesity-related cancers such as breast, colorectal, and other cancers in Korea. Decreased physical activity, increased fat and alcohol consumption, heavy smoking, and stress/depressed mood are the primary modifiable life-style risk factors for Koreans. Recently, public health interventions to encourage life-style changes have shown promising results in reducing the prevalence of severe obesity and metabolic syndrome.
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                Author and article information

                Contributors
                SuYeon Kwon: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: VisualizationRole: Writing – original draft
                Ji-Hong Park: Role: SupervisionRole: VisualizationRole: Writing – original draft
                Won-Seok Kim:
                ORCID: http://orcid.org/0000-0002-1199-5707
                Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Kyungdo Han: Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: VisualizationRole: Writing – review & editing
                Yookyung Lee: Role: InvestigationRole: MethodologyRole: Writing – review & editing
                Nam-Jong Paik: Role: ConceptualizationRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: Writing – review & editing
                Chung-Ying Lin: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 10 April 2018
                Publication date Collection: 2018
                Volume: 13
                Issue: 4
                Electronic Location Identifier: e0195713
                Affiliations
                [1 ] Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea
                [2 ] Department of Biostatistics, The Catholic University of Korea College of Medicine, Seoul, Korea
                Hong Kong Polytechnic University, HONG KONG
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-1199-5707
                Article
                Publisher ID: PONE-D-17-08894
                DOI: 10.1371/journal.pone.0195713
                PMC ID: 5892928
                PubMed ID: 29634768
                SO-VID: baad9cae-5860-458f-a496-b47ab8ac1bbb
                Copyright © © 2018 Kwon et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 6 March 2017
                Date accepted : 28 March 2018
                Page count
                Figures: 2, Tables: 3, Pages: 12
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Neurology
                Subject: Cerebrovascular Diseases
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Stroke
                Subject: Medicine and Health Sciences
                Subject: Vascular Medicine
                Subject: Blood Pressure
                Subject: Hypertension
                Subject: Medicine and Health Sciences
                Subject: Endocrinology
                Subject: Endocrine Disorders
                Subject: Diabetes Mellitus
                Subject: Medicine and Health Sciences
                Subject: Metabolic Disorders
                Subject: Diabetes Mellitus
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Quality of Life
                Subject: People and Places
                Subject: Population Groupings
                Subject: Ethnicities
                Subject: Korean People
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Educational Attainment
                Subject: Social Sciences
                Subject: Economics
                Subject: Human Capital
                Subject: Economics of Training and Education
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Korea
                Custom metadata
                Data Availability All data files are available from the Korea Centers for Disease Control and Prevention database through the following URLs: https://knhanes.cdc.go.kr/knhanes/sub03/sub03_02_02.do. Anybody, including an international researcher who signs up for membership, can get raw data from the webpage. However, the process for data access and user manual are only written in Korean. Kyungdo Han ( hkd917@ 123456naver.com ), the coauthor, can help provide the data used for the current study if interested researchers need assistance because of the language barrier.

                ScienceOpen disciplines: Uncategorized
                Data availability:
                ScienceOpen disciplines: Uncategorized

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