Background

Functional disability following stroke is greater in individuals with a history of obesity or diabetes; however, the joint association of obesity and diabetes with functional disability in stroke survivors has received little attention. Therefore, the purpose of this study was to examine the joint association of obesity and diabetes with functional disability among stroke survivors to identify stroke sub-populations at greatest risk for disability that could benefit from additional intervention.

Methods

Nationally representative, cross-sectional data from 38,834 stroke survivors from the 2015 and 2017 Behavioral Risk Factor Surveillance System (BRFSS) surveys were examined. Weighted and age-adjusted prevalence estimates and adjusted odds ratios (AOR, adjusted for sociodemographic characteristics) with 95% confidence intervals (CIs) were calculated to compare prevalence and odds for self-reported functional disability, stratified by obesity-diabetes status (i.e., neither condition, obesity only, diabetes only, both conditions) and sex.

Results

Overall disability prevalence was 42.15%. Compared to stroke survivors with neither condition (disability prevalence: 36.88%), prevalence and AORs for functional disability were highest in stroke survivors with both conditions (62.18%; AOR: 2.76, CI: 2.36-3.23), followed by diabetes only (45.64%; AOR: 1.69, CI: 1.44-1.99), and obesity only (41.26%; AOR: 1.41, CI: 1.23-1.35). Further, post hoc analysis indicated that AORs for functional disability were higher among females than males across obesity-diabetes categories.

Conclusions

Our results indicated a joint association of obesity and diabetes with functional disability that exceeded either condition alone, placing stroke survivors—and particularly females—with both health conditions at greatest risk. Targeted interventions that modify obesity and diabetes should be explored for their potential efficacy in decreasing functional disability among stroke survivors.