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Cerebrovasc Dis. 2004;18(4):277-82. Epub 2004 Aug 24.

Perceived family difficulties and prediction of 23-year stroke mortality among middle-aged men.

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Department of Epidemiology and Preventive Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.



To examine the association of indicators of family problems, support and coping style and prediction of stroke mortality among a large cohort of middle-aged men.


A cohort of 10,059 men aged > or =40 years at study inclusion that were tenured civil servants or municipal employees were followed for mortality over 23 years, for a total of about 200,000 person-years of follow-up. Mortality attributed to stroke and to CHD as underlying causes was determined. Subjects underwent a structured psychosocial questionnaire at baseline by trained interviewers, and associations between each indicator of perceived family difficulties, support and coping (9 indicators in total) and mortality from stroke and from CHD were estimated using the proportional hazard model by Cox.


During the 23-year follow-up period, 364 men died of stroke, and 1,098 men died of CHD. Among the indicators, perceived serious family difficulties at baseline, adjusted for traditional risk factors, were associated with higher risk of dying from stroke (HR 1.34, 95% CI 1.04-1.72), as were wife and children not tending to listen (HR 1.29, 95% CI 1.00-1.65), and person tending to keep feelings to oneself when conflict with wife (HR 1.27, 95% CI 1.03-1.37), while other indicators had associated HRs nearer unity. None of the variables assessed predicted mortality from CHD over a long-term follow-up.


Several indicators of perceived family problems, family support and coping style are related to risk of dying from stroke over a long-term follow-up among middle-aged men.

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