Background and Purpose— Outcomes among patients living alone at stroke onset could be directly affected by reduced access to acute therapies or indirectly through the effects of social isolation. We examined the associations between living alone at home and acute stroke care and outcomes in the Registry of the Canadian Stroke Network. Methods— Between 2003 and 2008, 10 048 patients with acute stroke (87% ischemic, 13% hemorrhagic) who were living at home were admitted to 11 Ontario hospitals. Outcomes included arrival ≤2.5 hours of onset, thrombolytic treatment, discharge home, 30-day and 1-year mortality, and 1-year readmission. The effects of living alone versus living with others were determined using multivariable logistic regression. Results— Overall, 22.8% (n=2288) of patients were living alone at home before stroke. Subjects living alone were significantly older (mean, 74.6 versus 71.5 years), more likely to be women (61.5% versus 41.4%), widowed (53.7% versus 12.3%), or single (21.5% versus 3.8%). Patients living alone were less likely to arrive within 2.5 hours (28.3% versus 40.0%; adjusted odds ratio, 0.54; 95% confidence interval, 0.48–0.60), to receive thrombolysis (8.0% versus 14.0%; adjusted odds ratio, 0.52; 95% confidence interval, 0.43–0.63), or to be discharged home (46.0% versus 54.7%; adjusted odds ratio, 0.65; 95% confidence interval, 0.58–0.73). There were no significant associations between living alone and mortality or readmission. Conclusions— Patients living alone had delayed hospital arrival, less thrombolytic therapy, and were less likely to return home. Greater understanding of the inter-relationships among living alone, social isolation, access to stroke care, and outcomes is needed.

Objective: To determine the risk of fractures after stroke.Methods: Using the Ontario Stroke Registry, we identified a population-based sample of consecutive patients seen in the emergency department or hospitalized with stroke (n 5 23,751) or TIA (n 5 11,240) at any of 11 stroke centers in Ontario, Canada, and discharged alive between July 1, 2003, and March 31, 2012. We compared the risk of low-trauma fractures in patients with stroke vs those with TIA using propensity score methods to adjust for differences in baseline factors. Secondary analyses compared fracture risk poststroke with that in age-/sex-matched controls without stroke or TIA (n 5 23,751) identified from the Ontario Registered Persons Database. Results:The 2-year rate of fracture was 5.7% in those with stroke compared to 4.8% in those with TIA (adjusted cause-specific hazard ratio [aHR] for those with stroke vs TIA 1.32; 95% confidence interval [CI] 1.19-1.46) and 4.1% in age-/sex-matched controls (aHR for those with stroke vs controls 1.47; 95% CI 1.35-1.60). In the cohort with stroke, factors associated with fractures were older age, female sex, moderate stroke severity, prior fractures or falls, and preexisting osteoporosis, rheumatoid arthritis, hyperparathyroidism, and atrial fibrillation.Conclusions: Stroke is associated with an increased risk of low-trauma fractures. Individuals with stroke and additional risk factors for fractures may benefit from targeted screening for low bone mineral density and initiation of treatment for fracture prevention. Stroke is a leading cause of adult disability, and up to two-thirds of stroke survivors have limitations in mobility.1 Stroke may also be associated with declines in bone mineral density and an increased risk of falls, both factors that can predispose to subsequent low-trauma (fragility) fractures. 2-10Previous studies have suggested an up to 4-fold increase in the risk of fractures in those with stroke compared to healthy controls. 7-13 However, it is not known how much of this fracture risk is due to the stroke itself rather than differences in other baseline factors such as age and comorbidity. A better understanding of both the fracture risk attributable to stroke and the specific factors associated with such fractures would allow for improved screening, prevention, and treatment of osteoporosis and fractures following stroke.We used data from a clinical stroke registry in Ontario, Canada, linked with administrative data, to evaluate the risk of fractures in patients with acute stroke compared to those with TIA. In order to focus on the contribution of stroke (rather than baseline comorbid conditions) to fracture risk, we selected patients with TIA as our reference population, as they are anticipated From the Institute for Clinical Evaluative Sciences