OBJECTIVES: The American Heart Association/American Stroke Association (AHA/ASA) has specific recommendation for secondary stroke prevention. The aim of this study was to compare health behaviors engagement between stroke survivors and non-stroke matched controls.

METHODS: We conducted a retrospective, cross-sectional, matched case-control study using data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) survey. We included older adults (age ≥ 50 years) who participated and completed interviews in 2015 BRFSS survey. We identified stroke survivors if they responded “yes” to the question: “Has a doctor, nurse, or other health professional ever told you that you had stroke?”. We generated propensity scores based on age, gender, race/ethnicity, and presence of co-occurring chronic conditions. Each stroke survivor was matched to three non-stroke controls using greedy matching algorithm with 8 to 1 digit matching. Stroke survivors were compared with controls on their physical activity, smoking; alcohol use, body mass index (BMI), last flu immunization, last physical check-up, last blood cholesterol check, heavy drinking, vegetable and fruit consumption. We used binomial logistic regression to assess association of health behaviors among stroke survivors compared to controls.

RESULTS: The final study sample consisted of 13,249 stroke survivors and 39,747 non-stroke controls after propensity score matching. Multivariable analyses revealed that stroke survivors had poor health behaviors in terms of BMI (Adjusted Odds Ratio (AOR): 0.78; 95%Confidence Interval (CI) 0.70-0.86; p<.0001), physical activity (AOR: 0.78; 95%CI 0.71-0.86; p<.0001), smoking status (AOR: 1.51; 95%CI 1.32-1.73; p <.0001), vegetable (AOR: 0.8; 95%CI 0.72-0.89; p<.0001) and fruit (AOR, 0.86; 95%CI 0.78-0.95; p<.0001) consumption but had lower likelihood of alcohol consumption (AOR, 0.86; 95%CI 0.78-0.95; p<.0001) compared to controls.

CONCLUSIONS: In this nationally representative sample of older adults in US, stroke survivors exhibited poorer health behavior engagement compared to matched controls underscoring the need of developing appropriate interventions for secondary stroke prevention.