Perceived hardships at midlife: Prediction of long-term stroke mortality

Objectives: The objective of this study is to examine the association between perceived hardships and long-term stroke mortality among a large cohort of middle-aged men. Background: Unlike cardiovascular morbidity and mortality, much less is known about the relationship between psychosocial factors and risk of stroke. Methods: A cohort of 10,059 men aged >= 40 years at study inclusion that were tenured civil servants or municipal employees were followed for mortality over a median of 28.1 years (IQR 18.9-34.3). During follow-up 6528 (64.9%) men died, 665 of stroke and 1769 of coronary heart disease (CHD). A composite score of perceived hardships was calculated based on a structured psychosocial questionnaire filled at baseline, assessing domains of work, family, and finance. Cox proportional hazard models were used adjusting for traditional risk factors and socio-economic status. Results: At baseline, subjects with higher hardship scores were slightly older, smoked more cigarettes, had higher prevalence of CHD, lower systolic blood pressure, higher anxiety levels and lower socio-economic status. Compared with the bottom tertile, the middle (HR 1.26, 95% CI 1.04-1.53) and top tertiles of the hardship score (HR 1.33, 95% CI 1.07-1.64) exhibited higher risk of stroke mortality (P for trend=0.008), while no significant association was found with long-term mortality from CHD. The magnitude of the association was comparable to that of diabetes (HR 1.30, 95% CI 1.02-1.66). Conclusion: Perceived hardships measured at midlife in a large cohort of apparently healthy men independently predict stroke mortality over long-term follow-up. (C) 2013 Elsevier Ireland Ltd. All rights reserved.