Disabled life expectancy with and without stroke: a 10-year Japanese prospective cohort study



A stroke is a debilitating condition that can cause lifelong disability, severely limiting the ability of individuals to perform daily activities. In Japan, strokes are the fourth leading cause of death; however, no previous studies have examined the influence of strokes on a disabled or disability-free life for older Japanese residents. This study aims to address this gap.


The study used data from the Nihon University Japanese Longitudinal Study of Aging (NUJLSOA) and incidence-based multistate life tables to estimate disabled and disability-free life expectancy based on the stroke status of Japanese residents aged 65 and older.


Japanese stroke survivors aged 65 who experienced an initial disability-free state could expect to live approximately 3 fewer total years of life, 4–5 fewer years in a disability-free state, and 1–2 more years in a disabled state compared to those without history of a stroke (p < 0.05). For those disabled at the beginning of the survey interval, the differences between individuals with and without stroke history were also similar to those disability-free at the beginning of the survey interval (2–4 and 5–6 fewer total and disability-free years, respectively) (p < 0.05). The same pattern was observed for older age groups.


Older adults who have experienced a stroke could experience a shorter total life expectancy, shorter disability-free life expectancy, and longer disabled life expectancy than those who have not experienced a stroke. These results can inform policymakers and rehabilitation practitioners on stroke survivor long-term care needs and their post-stroke health status.

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  1. 1.

    Mackay, J., Mensah, G. A., & Greenlund, K. (2004). The atlas of heart disease and stroke. Geneva: World Health Organization.

    Google Scholar 

  2. 2.

    Feigin, V. L., Forouzanfar, M. H., Krishnamurthi, R., et al. (2014). Global and regional burden of stroke during 1990–2010: Findings from the Global Burden of Disease Study 2010. The Lancet, 383(9913), 245–255.

    Google Scholar 

  3. 3.

    Ministry of Health Labour and Welfare. (2016). Deaths. Accessed November 24, 2017, from http://www.mhlw.go.jp/toukei/youran/aramashi/shibou.pdf.

  4. 4.

    Shinohara, Y. (2007). The changing face of the burden of stroke in Japan. International Journal of Stroke, 2, 133–135.

    PubMed  Google Scholar 

  5. 5.

    NIPPON DATA80 Research Group. (2006). Risk assessment chart for death from cardiovascular disease based on a 19-year follow-up study of a Japanese representative population: NIPPON DATA80. Circulation Journal, 70, 1249–1255.

    Google Scholar 

  6. 6.

    Kitamura, A., Sato, S., Kiyama, M., et al. (2008). Trends in the incidence of coronary heart disease and stroke and their risk factors in Japan, 1964 to 2003. Journal of the American College of Cardiology, 52(1), 71–79.

    PubMed  Google Scholar 

  7. 7.

    Miura, K. (2011). Epidemiology and prevention of hypertension in Japanese: How could Japan get longevity? EPMA Journal, 2, 59–64.

    PubMed  Google Scholar 

  8. 8.

    Ueshima, H. (2007). Explanation for the Japanese Paradox: Prevention of Increase in Coronary Heart Disease and Reduction in Stroke. Journal of Atherosclerosis and Thrombosis, 14(6), 278–286.

    PubMed  Google Scholar 

  9. 9.

    Kubo, M., Kiyohara, Y., Kato, I., et al. (2003). Trends in the incidence, mortality, and survival rate of cardiovascular disease in a Japanese Community. Stroke, 34, 2349–2354.

    Google Scholar 

  10. 10.

    Kita, Y., Turin, T. C., Ichikawa, M., et al. (2009). Trend of stroke incidence in a Japanese population: Takashima stroke registry, 1990–2001. International Journal of Stroke., 4, 241–249.

    CAS  PubMed  Google Scholar 

  11. 11.

    de Meijer, C., Koopmanschap, M., d’Uva, T. B., & Van Doorslaer, E. (2011). Determinants of long-term care spending: Age, time to death or disability? Journal of Health Economics, 30(2), 425–438.

    PubMed  Google Scholar 

  12. 12.

    Ministry of Health Labour and Welfare. 今後の高齢者人口の見通し. In: Welfare MoHLa, ed. Vol 2017. Tokyo: Ministry of Health Labour and Welfare; 2013:i.

  13. 13.

    Feigin, V. L., Lawes, C. M., Bennett, D. A., & Anderson, C. S. (2003). Stroke epidemiology: A review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. The Lancet Neurology, 2(1), 43–53.

    PubMed  Google Scholar 

  14. 14.

    Dworzynski, K., Ritchie, G., Fenu, E., MacDermott, K., Playford, E. D., & on behalf of the Guideline Development Group. (2013). Rehabilitation after stroke: Summary of NICE guidance. BMJ, 346, f3615.

    PubMed  Google Scholar 

  15. 15.

    Winstein, C. J., Stein, J., Arena, R., et al. (2016). Guidelines for adult stroke rehabilitation and recovery: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47, e98–e169.

    PubMed  Google Scholar 

  16. 16.

    Barofsky, I. (2012). Can quality or quality-of-life be defined? Quality of Life Research, 21, 625–631.

    PubMed  Google Scholar 

  17. 17.

    The WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28, 551–558.

    Google Scholar 

  18. 18.

    Geyh, S., Cieza, A., Kollerits, B., Grimby, G., & Stucki, G. (2007). Content comparison of health-related quality of life measures used in stroke based on the international classification of functioning, disability and health (ICF): A systematic review. Quality of Life Research, 16(5), 833–851.

    CAS  PubMed  Google Scholar 

  19. 19.

    Albrecht, G. L., & Devlieger, P. J. (1999). The disability paradox: High quality of life against all odds. Social Science and Medicine, 48(8), 977–988.

    CAS  PubMed  Google Scholar 

  20. 20.

    Viemerö, V., & Krause, C. (1998). Quality of life in individuals with physical disabilities. Psychotherapy and Psychosomatics, 67, 317–322.

    PubMed  Google Scholar 

  21. 21.

    Carod-Artal, F. J., & Egido, J. A. (2009). Quality of life after stroke: The importance of a good recovery. Cerebrovascular Diseases, 27(suppl 1), 204–214.

    PubMed  Google Scholar 

  22. 22.

    Haley, W. E., Roth, D. L., Kissela, B., Perkins, M., & Howard, G. (2011). Quality of life after stroke: A prospective longitudinal study. Quality of Life Research, 20(6), 799–806.

    PubMed  Google Scholar 

  23. 23.

    Reynolds, S. L., Haley, W. E., & Kozlenko, N. (2008). The impact of depressive symptoms and chronic diseases on active life expectancy in older Americans. The American Journal of Geriatric Psychiatry, 16(5), 425–432.

    PubMed  Google Scholar 

  24. 24.

    Clarke, P., & Black, S. E. (2005). Quality of life following stroke: Negotiating disability, identity, and resources. The Journal of Applied Gerontology, 24(4), 319–336.

    Google Scholar 

  25. 25.

    Saeki, S., & Toyonaga, T. (2010). Determinants of early return to work after first stroke in Japan. Journal of Rehabilitation Medicine, 42, 254–258.

    PubMed  Google Scholar 

  26. 26.

    Alaszewski, A., Alaszewski, H., Potter, J., & Penhale, B. (2007). Working after a stroke: Survivors’ experiences and perceptions of barriers to and facilitators of the return to paid employment. Disability and Rehabilitation, 29(24), 1858–1869.

    PubMed  Google Scholar 

  27. 27.

    Kiyohara, Y., Kubo, M., Kato, I., et al. (2003). ten-year prognosis of stroke and risk factors for death in a Japanese community: The Hisayama Study. Stroke, 34, 2343–2348.

    PubMed  Google Scholar 

  28. 28.

    Mathisen, S. M., Dalen, I., Larsen, J. P., & Kurz, M. (2016). Long-term mortality and its risk factors in stroke survivors. Journal of Stroke and Cerebrovascular Diseases, 25(3), 635–641.

    PubMed  Google Scholar 

  29. 29.

    Rønning, O. M. (2012). Very long-term mortality after ischemic stroke: Predictors of cardiovascular death. Acta Neurologica Scandinavica, 127(Suppl. 196), 69–72.

    Google Scholar 

  30. 30.

    Putaala, J., Curtze, S., Hiltunen, S., Tolppanen, H., Kaste, M., & Tatlisumak, T. (2009). Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke. Stroke, 40(8), 2698–2703.

    PubMed  Google Scholar 

  31. 31.

    Hankey, G. J., Jamrozik, K., Broadhurst, R. J., Forbes, S., & Anderson, C. S. (2002). Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990. Stroke, 33, 1034–1040.

    PubMed  Google Scholar 

  32. 32.

    Yang, Y., Shi, Y.-Z., Zhang, N., et al. (2016). The disability rate of 5-year post-stroke and its correlation factors: A national survey in China. PLoS ONE, 11(11), e0165341.

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Hung, M.-C., Hsieh, C.-L., Hwang, J.-S., Jeng, J.-S., & Wang, J.-D. (2013). Estimation of the long-term care needs of stroke patients by integrating functional disability and survival. PLoS ONE, 8(10), e75605.

    CAS  PubMed  PubMed Central  Google Scholar 

  34. 34.

    Lutz, B. J., Ellen Young, M., Cox, K. J., Martz, C., & Rae, Creasy K. (2011). The crisis of stroke: Experiences of patients and their family caregivers. Top Stroke Rehabil., 18(6), 786–797.

    PubMed  Google Scholar 

  35. 35.

    Chang, H.-Y., Chiou, C.-J., & Chen, N.-S. (2010). Impact of mental health and caregiver burden on family caregivers’ physical health. Archives of Gerontology and Geriatrics, 50(3), 267–271.

    PubMed  Google Scholar 

  36. 36.

    Moon, L., Moise, P., & Jacobzone, S. (2003). The ARD-Stroke Experts Group. Stroke care in OECD countries: A comparison of treatment, costs and outcomes in 17 countries. OECD Health Working Papers 2003; No. 5, OECD Publishing.

  37. 37.

    Evers, S. M., Struijs, J. N., Ament, A. J., van Genugten, M. L., Jager, J. H. C., & van den Bos, G. A. (2004). International comparison of stroke cost studies. Stroke, 35(5), 1209–1215.

    PubMed  Google Scholar 

  38. 38.

    American Heart Association. (2015). Heart disease and stroke statistics—2015 update: A report from the American Heart Association. Circulation, 131, e29–e32.

    Google Scholar 

  39. 39.

    Hattori, N., Hirayama, T., & Katayama, Y. (2012). Medical care for chronic-phase stroke in Japan. Neurologia Medico-chirurgica, 52(4), 175–180. (Tokyo).

    PubMed  Google Scholar 

  40. 40.

    Laditka, J. N., & Laditka, S. B. (2014). Stroke and active life expectancy in the United States, 1999-2009. Disability and Health Journal, 7, 472–477.

    PubMed  Google Scholar 

  41. 41.

    Fang, X.-H., Zimmer, Z., Kaneda, T., Tang, Z., & Xiang, M.-J. (2009). Stroke and active life expectancy among older adults in Beijing, China. Disability and Rehabilitation, 31(9), 701–711.

    PubMed  Google Scholar 

  42. 42.

    Yong, V., & Saito, Y. (2012). Are there education differentials in disability and mortality transitions and active life expectancy among Japanese older adults? Findings from a 10-year prospective cohort study. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 67(3), 343–353.

    Google Scholar 

  43. 43.

    Statistics Bureau. E-STAT (Portal Site of Official Statistics of Japan). (2019). Accessed March 15, 2019, from https://www.e-stat.go.jp/stat-search/files?page=1&toukei=00450022&tstat=000001031167.

  44. 44.

    Mozaffarian, D., Benjamin, E. J., Go, A. S., et al. (2016). Heart disease and stroke statistics-2016 update a report from the American Heart Association. Circulation, 133(4), e38–e48.

    Google Scholar 

  45. 45.

    Shah, R. S., & Cole, J. W. (2010). Smoking and stroke: the more you smoke the more you stroke. Expert Review of Cardiovascular Therapy, 8(7), 917–932.

    PubMed  PubMed Central  Google Scholar 

  46. 46.

    Wang, Y., Xu, J., Zhao, X., et al. (2013). Association of hypertension with stroke recurrence depends on ischemic stroke subtype. Stroke, 44(5), 1232–1237.

    CAS  PubMed  Google Scholar 

  47. 47.

    Janghorbani, M., Hu, F. B., Willett, W. C., et al. (2007). Prospective study of type 1 and type 2 diabetes and risk of stroke subtypes: The Nurses’ Health Study. Diabetes Care, 30(7), 1730–1735.

    PubMed  Google Scholar 

  48. 48.

    Banerjee, C., Moon, Y. P., Paik, M. C., et al. (2012). Duration of diabetes and risk of ischemic stroke: The Northern Manhattan Study. Stroke, 43(5), 1212–1217.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Saito, Y., Robine, J.-M., & Crimmins, E. M. (2014). The methods and materials of health expectancy. Statistical Journal of the IAOS, 30(3), 209–223.

    PubMed  PubMed Central  Google Scholar 

  50. 50.

    Cai, L., Hayward, M., Saito, Y., Lubitz, J., Hagedorn, A., & Crimmins, E. (2010). Estimation of multi-state life table functions and their variability from complex survey data using the SPACE Program. Demographic Research, 22(6), 129–158.

    PubMed  PubMed Central  Google Scholar 

  51. 51.

    WHO. (2012). Japan: WHO statistical profile. Accessed April 20, 2016, from http://www.who.int/countries/jpn/en/.

  52. 52.

    Russo, T., Felzani, G., & Marini, C. (2011). Stroke in the very old: A systematic review of studies on incidence, outcome, and resource use. Journal of Aging Research. https://doi.org/10.4061/2011/108785.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Forti, P., Maioli, F., Procaccianti, G., et al. (2013). Independent predictors of ischemic stroke in the elderly: Prospective data from a stroke unit. Neurology, 80(1), 29–38.

    PubMed  Google Scholar 

  54. 54.

    Petrea, R. E., Beiser, A. S., Seshadri, S., Kelly-Hayes, M., Kase, C. S., & Wolf, P. A. (2009). Gender differences in stroke incidence and poststroke disability in the Framingham heart study. Stroke, 40(4), 1032–1037.

    PubMed  PubMed Central  Google Scholar 

  55. 55.

    Laditka, S. B., & Laditka, J. N. (2009). Active life expectancy: A central measure of population health. In P. Uhlenberg (Ed.), International handbook of population aging (Vol. 1, pp. 543–565). Dordrecht: Springer.

    Google Scholar 

  56. 56.

    Yang, Q., Botto, L. D., Erickson, J. D., et al. (2006). Improvement in stroke mortality in Canada and the United States, 1990 to 2002. Circulation, 113(10), 1335–1343.

    PubMed  Google Scholar 

  57. 57.

    Koton, S., Schneider, A. L., Rosamond, W. D., et al. (2014). Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA, 312(3), 259–268.

    CAS  PubMed  Google Scholar 

  58. 58.

    Sze, K.-H., Wong, E., Or, K. H., Lum, C. M., & Woo, J. (2000). Factors predicting stroke disability at discharge: A study of 793 Chinese. Archives of Physical Medicine and Rehabilitation, 81, 876–880.

    CAS  PubMed  Google Scholar 

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The initial work was supported by a grant obtained by the Nihon University Population Research Institute from the “Academic Frontier” Project for Private Universities: matching fund subsidy from MEXT (Ministry of Education, Culture, Sports, Science and Technology), 2006–2010. The funding source had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of paper.

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Chiu, CT., Yong, V., Chen, HW. et al. Disabled life expectancy with and without stroke: a 10-year Japanese prospective cohort study. Qual Life Res 28, 3055–3064 (2019). https://doi.org/10.1007/s11136-019-02246-1

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  • Life expectancy
  • Stroke
  • Disabled life expectancy
  • Disability
  • Mortality