Having children is associated with a longer survival after ischemic stroke. A population-based cohort study of Swedish men and women aged 65 years and older

Abstract

Introduction Elderly parents have lower mortality than childless individuals. Suggested explanations for this finding include selection into parenthood, influence on health behaviors, and social support from adult children to their ageing parents. Previous studies have mostly focused on the association between number of children and mortality rates in the population. However, mortality rates are determined by both incidence of–and survival from disease and little is known about whether the presence of children affects survival once a disease has occurred. Since stroke often results in functional limitations, support from adult children may be of particular importance. Here, we examine whether the presence of children matters for survival after stroke among older Swedish men and women. Methods This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older with their first ischemic stroke between 1998 and 2002 (30379 men and 32201 women) were followed 12 years for survival. The study population was restricted to individuals who survived the subacute phase of the stroke, corresponding to the first 28 days. Hazard ratios (HR) and 95% > confidence intervals for all-cause mortality were calculated by number of children using Cox proportional hazard regression stratified by sex and marital status and adjusted for education and income. In further analyses, we adjusted for length of hospital stay as a proxy for stroke severity as well as number of previous hospitalizations. Predicted median survival was estimated based on the final regression models. Results Childlessness and having only one child was associated with higher mortality after stroke compared to having two children both among men and women. The relative survival disadvantage of childless individuals was largest among married women (HR: 1.28 [1.19–1.37]) and smallest among married men (HR: 1.07 [1.01–1.12]). For unmarried individuals, the estimated HR were 1.18 [1.14–1.23] among women 1.14 [1.08–1.20] among men. There were no differences between parents of two and parents of three or more children. The differences in predicted median survival between childless individuals and those with two children were 4 and 7 months among married and unmarried men, and 16 and 8 months among married and unmarried women, respectively. Conclusions Having children is associated with a longer survival after stroke among men and women regardless of marital status and despite adjusting for several potential confounding factors. The absolute differences in predicted median survival time between parents of two children compared to childless individuals were substantial considering the relatively short survival of individuals over the age of 65 with stroke (the median survival was approximately 5 years in the study population). Our findings further suggest that the presence of children is especially connected to married women's survival. These results may have implications for how to improve informal care for childless older individuals.