Background: Stroke remains a major public health burden. Few studies have focused on the age differences in the associations of behavioral and psychosocial factors with stroke while no study focusing on the effect of severe psychological distress (SPD) on stroke has been conducted. The aim of this study was to examine the age differences in these risk factors for stroke as young (18-44 years), middle aged (45-64 years), and elderly (65 years or older). Methods: A total of 1,258 adults with stroke and 39,985 controls were selected from the 2005 California Health Interview Survey. Multiple logistic regression analyses were used to estimate the associations of the factors with stroke at different ages. Results: The prevalence of SPD was 10% in cases and 3.6% in controls, respectively. Overall, current smoking, lack of physical activity, alcohol consumption, SPD, type II diabetes, male, older age, and unemployment were all associated with a higher prevalence of stroke. Practically, we found that smoking and SPD were associated with the prevalence of stroke in young adults, lack of physical activity was associated with the prevalence of stroke in middle-aged adults, and lack of physical activity and SPD were associated with the prevalence of stroke in the elderly. Conclusions: Appropriate intervention for reducing stroke and eliminating its disparities may be developed separately at each age.

Mathers CD, Loncar D: Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442.
Roger VL, Go AS, Lloyd-Jones DM, et al: Heart disease and stroke statistics - 2012 update: a report from the American Heart Association. Circulation 2012;125:e2-e220.
Schiller JS, Lucas JW, Ward BW, Peregoy JA: Summary health statistics for US adults: National Health Interview Survey, 2010. Vital Health Stat 2012;10:1-207.
1995 Heart and Stroke Facts. Dallas, American Heart Association, 1996.
Centers for Disease Control and Prevention (CDC). Vital Statistics Public Use Data Files - 2008 Mortality Multiple Cause Files. (accessed June 23, 2012).
Lloyd-Jones DM, Adams RJ, Brown TM, et al: Heart disease and stroke statistics—2010 update: a report from the American Heart Association. Circulation 2010;121:e46-e215.
Heidenreich PA, Trogdon JG, Khavjou OA, et al: Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association. Circulation 2011;123:933-944.
Lloyd-Jones DM, Hong Y, Labarthe D, et al: Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation 2010;121:586-613.
Liao Y, Greenlund KJ, Croft JB, Keenan NL, Giles WH: Factors explaining excess stroke prevalence in the US stroke belt. Stroke 2009;40:3336-3341.
Reeves MJ, Bushnell CD, Howard G, et al: Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008;7:915-926.
Avgil Tsadok M, Jackevicius CA, Rahme E, et al: Sex differences in stroke risk among older patients with recently diagnosed atrial fibrillation. JAMA 2012;307:1952-1958.
Kessler RC, Andrews G, Colpe LJ, et al: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959-976.
Kessler RC, Barker PR, Colpe LJ, et al: Screening for serious mental illness in the general population. Arch Gen Psychiatry 2003;60:184-189.
Zhang Y, Galloway JM, Welty TK, et al: Incidence and risk factors for stroke in American Indians: the Strong Heart Study. Circulation 2008;118:1577-1584.
Myint PK, Sinha S, Luben RN, et al: Risk factors for first-ever stroke in the EPIC-Norfolk prospective population-based study. Eur J Cardiovasc Prev Rehabil 2008;15:663-669.
You JS, Park S, Chung SP: Mobile message for a better stroke recognition: the new concept of national campaign. Stroke 2008;39:e42.
Physical Activity Guidelines Advisory Committee Report, 2008. Washington, US Department of Health and Human Services, 2008. (accessed June 24, 2012).
Wendel-Vos GC, Schuit AJ, Feskens EJ, et al: Physical activity and stroke: a meta-analysis of observational data. Int J Epidemiol 2004;33:787-798.
Lee CD, Folsom AR, Blair SN: Physical activity and stroke risk: a meta-analysis. Stroke 2003;34:2475-2481.
Carney RM, Freedland KE: Psychological distress as a risk factor for stroke-related mortality. Stroke 2002;33:5-6.
House A, Knapp P, Bamford J, Vail A: Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 2001;32:696-710.
Simons LA, McCallum J, Friedlander Y, Simons J: Risk factors for ischemic stroke: Dubbo Study of the elderly. Stroke 1998;29:1341-1346.
Jonas BS, Mussolino ME: Symptoms of depression as a prospective risk factor for stroke. Psychosom Med 2000;62:463-471.
Hamer M, Kivimaki M, Stamatakis E, Batty GD: Psychological distress as a risk factor for death from cerebrovascular disease. CMAJ 2012;184:1461-1466.
Swartz JA, Lurigio AJ: Screening for serious mental illness in populations with co-occurring substance use disorders: performance of the K6 scale. J Subst Abuse Treat 2006;31:287-296.
Baggaley RF, Ganaba R, Filippi V, et al: Detecting depression after pregnancy: the validity of the K10 and K6 in Burkina Faso. Trop Med Int Health 2007;12:1225-1229.
Hankey GJ, Jamrozik K, Broadhurst RJ, et al: Long-term risk of first recurrent stroke in the Perth Community Stroke Study. Stroke 1998;29:2491-2500.
Tuttolomondo A, Pinto A, Salemi G, et al: Diabetic and non-diabetic subjects with ischemic stroke: differences, subtype distribution and outcome. Nutr Metab Cardiovasc Dis 2008;18:152-157.
Brown RD, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO: Stroke incidence, prevalence, and survival: secular trends in Rochester, Minnesota, through 1989. Stroke 1996;27:373-380.
Pleis JR, Lethbridge-Cejku M: Summary health statistics for US adults: National Health Interview Survey, 2006. Vital Health Stat 2007;10:1-153.
Lofmark U, Hammarstrom A: Evidence for age-dependent education-related differences in men and women with first-ever stroke. Neuroepidemiology 2007;28:135-141.
Carson AP, Rose KM, Catellier DJ, et al: Employment status, coronary heart disease, and stroke among women. Ann Epidemiol 2009;19:630-636.
Suadicani P, Andersen LL, Holtermann A, Mortensen OS, Gyntelberg F: Perceived psychological pressure at work, social class, and risk of stroke: a 30-year follow-up in a Copenhagen male study. J Occup Environ Med 2011;53:1388-1395.
Howard G, Anderson R, Sorlie P, et al: Ethnic differences in stroke mortality between non-Hispanic whites, Hispanic whites, and blacks: the National Longitudinal Mortality Study. Stroke 1994;25:2120-2125.
Gillum RF: Stroke in blacks. Stroke 1988;19:1-9.
Sacco RL, Boden-Albala B, Gan R, et al: Stroke incidence among white, black, and Hispanic residents of an urban community: the Northern Manhattan Stroke Study. Am J Epidemiol 1998;147:259-268.
Kissela B, Schneider A, Kleindorfer D, et al: Stroke in a biracial population: the excess burden of stroke among blacks. Stroke 2004;35:426-431.
Giles WH, Kittner SJ, Hebel JR, Losonczy KG, Sherwin RW: Determinants of black-white differences in the risk of cerebral infarction: the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study. Arch Intern Med 1995;155:1319-1324.
Gillum RF: Risk factors for stroke in blacks: a critical review. Am J Epidemiol 1999;150:1266-1274.
Kittner SJ, White LR, Losonczy KG, Wolf PA, Hebel JR: Black-white differences in stroke incidence in a national sample: the contribution of hypertension and diabetes mellitus. JAMA 1990;264:1267-1270.
O'Mahony PG, Dobson R, Rodgers H, James OF, Thomson RG: Validation of a population screening questionnaire to assess prevalence of stroke. Stroke 1995;26:1334-1337.
Engstad T, Bonaa KH, Viitanen M: Validity of self-reported stroke: the Tromsø Study. Stroke 2000;31:1602-1607.
Nelson DE, Holtzman D, Bolen J, Stanwyck CA, Mack KA: Reliability and validity of measures from the Behavioral Risk Factor Surveillance System (BRFSS). Social Prev Med 2001;46(suppl 1):S3-S42.
Sims NR, Muyderman H: Mitochondria, oxidative metabolism and cell death in stroke. Biochim Biophys Acta 2010;1802:80-91.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.