Nils Skajaa

TY - JOUR

T1 - Labour market participation and retirement after stroke in Denmark

T2 - registry based cohort study

AU - Skajaa, Nils

AU - Adelborg, Kasper

AU - Horváth-Puhó, Erzsébet

AU - Rothman, Kenneth J

AU - Henderson, Victor W

AU - Thygesen, Lau Caspar

AU - Sørensen, Henrik Toft

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2023/1

Y1 - 2023/1

N2 - OBJECTIVE: To examine labour market participation and retirement among patients with stroke and matched people in the general population according to stroke subtype.DESIGN: Nationwide, population based, matched cohort study.SETTING: Danish Stroke Registry, covering all Danish hospitals, and other nationwide registries (2005-18).PARTICIPANTS: Patients (aged 18-60 years and active in the labour market) with a first time diagnosis of ischaemic stroke (n=16 577), intracerebral haemorrhage (n=2025), or subarachnoid haemorrhage (n=4305), and individuals from the general population, matched on age, sex, and calendar year (n=134 428). The median Scandinavian stroke scale score was 55.MAIN OUTCOME MEASURES: Unweighted prevalences of labour market participation, receipt of sick leave benefits, receipt of disability pension, voluntary early retirement, state pension, and death were computed for each week and up to five years after stroke diagnosis. A log-linear Poisson model was used to obtain exact prevalence estimates as well as propensity score weighted prevalence differences and prevalence ratios at six months, one year, two years, and five years after stroke diagnosis.RESULTS: Most patients (62% of those with ischaemic stroke, 69% of those with intracerebral haemorrhage, and 52% of those with subarachnoid haemorrhage) went on sick leave within three weeks of diagnosis. Prevalence of labour market participation among patients with ischaemic stroke compared with matched individuals from the general population was 56.6% versus 96.6% at six months, and 63.9% versus 91.6% at two years. Prevalence of sick leave was 39.8% versus 2.6% at six months, and 15.8% versus 3.8% at two years. Prevalence of receipt of a disability pension was 0.9% versus 0.2% at six months, and 12.2% versus 0.6% at two years. Adjusting for socioeconomic and comorbidity differences between patients and matched individuals from the general population using propensity score weighting methods had little impact on contrasts. Patients with intracerebral haemorrhage had higher prevalences of sick leave and receipt of a disability pension and thus a lower prevalence of labour market participation, while prevalences for patients with subarachnoid haemorrhage were similar in magnitude to those for patients with ischaemic stroke.CONCLUSIONS: In a highly resourced country, about two thirds of working age adults with ischaemic stroke of primarily mild severity participated in the labour market two years after diagnosis. Sick leave and receipt of a disability pension were the most common reasons for non-participation. Patients with intracerebral haemorrhage were less likely to return to the labour market than patients with ischaemic stroke and subarachnoid haemorrhage.

AB - OBJECTIVE: To examine labour market participation and retirement among patients with stroke and matched people in the general population according to stroke subtype.DESIGN: Nationwide, population based, matched cohort study.SETTING: Danish Stroke Registry, covering all Danish hospitals, and other nationwide registries (2005-18).PARTICIPANTS: Patients (aged 18-60 years and active in the labour market) with a first time diagnosis of ischaemic stroke (n=16 577), intracerebral haemorrhage (n=2025), or subarachnoid haemorrhage (n=4305), and individuals from the general population, matched on age, sex, and calendar year (n=134 428). The median Scandinavian stroke scale score was 55.MAIN OUTCOME MEASURES: Unweighted prevalences of labour market participation, receipt of sick leave benefits, receipt of disability pension, voluntary early retirement, state pension, and death were computed for each week and up to five years after stroke diagnosis. A log-linear Poisson model was used to obtain exact prevalence estimates as well as propensity score weighted prevalence differences and prevalence ratios at six months, one year, two years, and five years after stroke diagnosis.RESULTS: Most patients (62% of those with ischaemic stroke, 69% of those with intracerebral haemorrhage, and 52% of those with subarachnoid haemorrhage) went on sick leave within three weeks of diagnosis. Prevalence of labour market participation among patients with ischaemic stroke compared with matched individuals from the general population was 56.6% versus 96.6% at six months, and 63.9% versus 91.6% at two years. Prevalence of sick leave was 39.8% versus 2.6% at six months, and 15.8% versus 3.8% at two years. Prevalence of receipt of a disability pension was 0.9% versus 0.2% at six months, and 12.2% versus 0.6% at two years. Adjusting for socioeconomic and comorbidity differences between patients and matched individuals from the general population using propensity score weighting methods had little impact on contrasts. Patients with intracerebral haemorrhage had higher prevalences of sick leave and receipt of a disability pension and thus a lower prevalence of labour market participation, while prevalences for patients with subarachnoid haemorrhage were similar in magnitude to those for patients with ischaemic stroke.CONCLUSIONS: In a highly resourced country, about two thirds of working age adults with ischaemic stroke of primarily mild severity participated in the labour market two years after diagnosis. Sick leave and receipt of a disability pension were the most common reasons for non-participation. Patients with intracerebral haemorrhage were less likely to return to the labour market than patients with ischaemic stroke and subarachnoid haemorrhage.

KW - Adult

KW - Humans

KW - Cohort Studies

KW - Retirement

KW - Stroke/epidemiology

KW - Subarachnoid Hemorrhage/epidemiology

KW - Brain Ischemia/epidemiology

KW - Pensions

KW - Ischemic Stroke

KW - Registries

KW - Sick Leave

KW - Cerebral Hemorrhage/epidemiology

KW - Denmark/epidemiology

U2 - 10.1136/bmj-2022-072308

DO - 10.1136/bmj-2022-072308

M3 - Journal article

C2 - 36596583

VL - 380

JO - BMJ (Clinical research ed.)

JF - BMJ (Clinical research ed.)

SN - 0959-8146

M1 - e072308

ER -