Parents have lower mortality than childless individuals, and one possible explanation is support provided by adult children. Since stroke often results in functional limitations, support from 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.
This prospective cohort study linked data from several Swedish population registers. Individuals aged 65 years and older hospitalized for their first ischemic stroke between 1998 and 2002 (33 960 men and 36 189 women) were followed 12 years for survival. Hazard ratios 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, income and comorbidities.
Childlessness and having only one child was associated with higher mortality after stroke compared with having two children among men and women. The relative survival disadvantage of childless individuals was largest among married women [HR 1.28 (1.18-1.39)] and smallest among married men [1.09 (1.03-1.15)]. 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 15 and 9 months among married and unmarried women, respectively.
Having children is associated with a longer survival after stroke among men and women regardless of marital status. Our findings further suggest that the presence of children is especially connected to married women's survival. These results may have implications for the improvement of informal care for childless older individuals.
The objective of the study was to compare patients with hip fracture in the Swedish Hip Fracture Register (SHR) and the National Patient Register (NPR) between 2008 and 2017 regarding coverage, agreement, and representativeness.
The NPR and SHR were linked through the personal identity number assigned to all residents of Sweden. The proportion of matching records in both registers was calculated in total, for different fracture types, and for the first and recurrent fractures separately. Representativeness was estimated using logistic regression and survival analysis.
The agreement between fracture types in both registers was excellent, but our comparison with the SHR indicated that the NPR may overestimate the number of recurrent fractures in Sweden. The SHR covers more than 80% of all hip fractures in the NPR. Patients in the SHR were similar to those in the NPR with regard to many, but not all, characteristics and long-term survival. However, patients who die shortly after hip fracture were underreported to the SHR.
Both registers are valuable data sources for epidemiological research. Although neither register constitutes a gold standard, their excellent agreement suggests high-data quality. Nevertheless, both registers have some limitations that may be relevant depending on the research question under study.
