Long-term functional recovery after first XXXX : the Northern Manhattan Study.

@entity1 @entity583 @entity64 @entity385
BACKGROUND AND PURPOSE: Several factors predict functional status after @entity64 , but most studies have included hospitalized @entity1 with limited follow-up. We hypothesized that @entity1 with @entity385 experience functional decline over 5 years independent of recurrent @entity64 and other risk factors. METHODS: In the population-based Northern Manhattan Study, @entity1 > or =40 years of age with incident @entity385 were prospectively followed using the Barthel Index at 6 months and annually to 5 years. Baseline @entity64 severity was categorized as mild (National Institutes of Health @entity64 Scale <6), moderate (6 to 13), and severe (> or =14). Follow-up was censored at death, recurrent @entity64 , or @entity583 . Generalized Estimating Equations provided ORs and 95% CIs for predictors of favorable (Barthel Index > or =95) versus unfavorable (Barthel Index <95) functional status after adjusting for demographic and medical risk factors. RESULTS: Of 525 @entity1 , mean age was 68.6+/-12.4 years, 45.5% were male, 54.7% Hispanic, 54.7% had Medicaid/no insurance, and 35.1% had moderate @entity64 . The proportion with Barthel Index > or =95 declined over time (OR, 0.91; 95% CI, 0.84 to 0.99). Changes in Barthel Index by insurance status were confirmed by a significant interaction term (beta for interaction=-0.167, P=0.034); those with Medicaid/no insurance declined (OR, 0.84; P=0.003), whereas those with Medicare/private insurance did not (OR, 0.99; P=0.92). CONCLUSIONS: The proportion of @entity1 with functional independence after @entity64 declines annually for up to 5 years, and these effects are greatest for those with Medicaid or no health insurance. This decline is independent of age, @entity64 severity, and other predictors of functional decline and occurs even among those without recurrent @entity64 or @entity583 .
