Long-term increased risk of unemployment after young stroke

Maaijwee, Noortje A.M.; Rutten-Jacobs, Loes C.A.; Arntz, Renate M.; Schaapsmeerders, Pauline; Schoonderwaldt, Hennie C.; Dijk, Ewoud J. van; Leeuw, Frank‐Erik de

doi:10.1212/wnl.0000000000000817

Cited by 79 publications

(75 citation statements)

References 22 publications

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“…Poor outcomes are common after stroke at all ages [3-6], but the impact of stroke in younger adults can be particularly devastating due to the loss or change in employment and family roles [7-9]. While rare causes of stroke are more common in younger patients than in older patients [10], there is increasing awareness that young adults with stroke exhibit conventional vascular risk factors [1, 11, 12] and benefit from receiving standard evidence-based therapies.…”

Section: Introductionmentioning

confidence: 99%

Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry

et al. 2017

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Background: Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18–64 years) require examination separately to older adults (aged ≥65 years) who experience acute stroke. Methods: Data from the Australian Stroke Clinical Registry (2010–2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons. Results: Compared to older patients (age ≥65 years) among 26,220 registrants, 6,526 (25%) younger patients (age 18–64 years) were more often male (63 vs. 51%; p < 0.001), born in Australia (70 vs. 63%; p < 0.001), more often discharged home from acute care (56 vs. 38%; p < 0.001), and less likely to receive antihypertensive medication (61 vs. 73%; p < 0.001). Younger patients had a 74% greater odds of having lower HRQoL compared to an equivalent aged-matched general population (adjusted OR 1.74, 95% CI 1.56–1.93, p < 0.001). Conclusions: Younger stroke patients exhibited distinct differences from their older counterparts with respect to demographic and clinical characteristics, prescription of antihypertensive medications and residual health status.

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Section: Introductionmentioning

confidence: 99%

Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry

et al. 2017

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“…review of Daniel et al [2] . In a recently published study upon a long-term increased risk of unemployment after stroke at young age, even after, on average, 8-year followup after stroke, the unemployment rate was between 25.9 and 43.9% [4] . In our study, after a median of 3-year follow-up, 20.7% of patients aged 18-45 did not come back to work and we outline that one third of these patients had minimal or no neurological deficit at all.…”

Section: Discussionmentioning

confidence: 92%

“…It is estimated that about half of all stroke survivors return to some kind of employment, and that about one third of patients are not able to survive without the help of another person [1][2][3][4] . Working age adults have responsibilities for generating an income and supporting family members, so return to work is a key goal in recovery from disabling illness such as stroke.…”

Section: Introductionmentioning

confidence: 99%

Return to Paid Work after Ischemic Stroke in Patients Treated with Intravenous Thrombolysis

et al. 2016

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Background: There are no available data confirming the efficacy of intravenous thrombolytic (IVT) treatment on the return to work as one of important outcome measure after acute ischemic stroke (IS). The aim of this study was to analyze the influence of IVT treatment on the return to work after stroke. Methods: This matched cohort study included 279 patients with acute IS (146 treated with IVT and 133 matched patients without IVT) admitted to the Stroke Unit between 2007 and 2013. All patients were working in paid employment immediately before stroke onset. The main outcome measure was return to full-time paid work during follow-up period. Results: After a median follow-up period of 3 years (range 1-7 years), the prevalence of stroke survivors returning to paid work was 42.1% in the IVT group and 33.3% in the non-IVT group (hazard ratio 1.28, 95% CI 0.86-1.91), and IVT treatment was associated with a higher chance of returning to full-time jobs (OR 2.07, 95% CI 1.21-3.51). After adjustment for possible variables, IVT was an independent predictor of returning to full-time jobs. Conclusion: IVT treatment was a positive predictor of returning to full-time work after stroke.

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“…A sizeable proportion (up to 53%) of young stroke patients do not return to the workforce, and an additional 23% require occupational adjustment in order to resume work. 8 Over a span of 3 decades (1980-2010), the investigators prospectively accrued and followed a relatively large number of young stroke patients. 7 In this issue of Neurology ® , an esteemed group of researchers in the field of young adult stroke report on the prevalence, excess risk, and risk factors of unemployment after a stroke or TIA in young individuals in the Netherlands.…”

Section: Life After Strokementioning

confidence: 99%

Life after stroke

Singhal

2014

Neurology

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Stroke is a common, disabling, and expensive condition. In the Unites States alone, stroke prevalence exceeds 3.2%, with an annual cost approaching $40 billion, including the cost of health care services, medications, and lost productivity. 1 Stroke is not restricted to old age. Nearly 1 of every 5 strokes occurs in young adults; strokes can also occur in adolescents and children. 2 Several lines of evidence have raised public health concerns about the rising prevalence of traditional vascular risk factors in young individuals, and their potential role in increasing the risk for ischemic stroke, recurrent stroke, and poststroke mortality. 3,4 These data have started drawing attention to the problem of stroke in the young, 2 and have already stimulated research in the field.Compared to stroke in the aged population, stroke at young age incurs a disproportionately large economic cost by leaving victims disabled in, or prior to, their most productive years. A sizeable proportion (up to 53%) of young stroke patients do not return to the workforce, and an additional 23% require occupational adjustment in order to resume work. 5,6 Factors such as poststroke functional independence, positive attitude, and type of work are independent predictors of resuming work. 7 In this issue of Neurology ® , an esteemed group of researchers in the field of young adult stroke report on the prevalence, excess risk, and risk factors of unemployment after a stroke or TIA in young individuals in the Netherlands. 8 Over a span of 3 decades , the investigators prospectively accrued and followed a relatively large number of young stroke patients. By obtaining de-identified data from the Dutch Central Bureau of Statistics, a national registry of citizens who receive disability payments, these authors, in contrast to previous studies, could compare disability payments (a marker for unemployment) in stroke patients vs the working population. Nearly 30% of this stroke cohort received disability payments after a mean follow-up of 8.1 years, with 84.2% on full disability and the rest on partial disability. The higher risk for unemployment in stroke cases was evident for both sexes and across most age groups. Those in the 35-44 years age group endured the highest risk for unemployment, at a time when individuals are typically the most productive. As expected, patients with brain hemorrhage had the highest rates of unemployment. Baseline stroke severity and the duration of follow-up were associated with a higher risk for unemployment. Interestingly, excluding TIA patients from the analysis did not substantially change the risk for unemployment. These results suggest an enduring effect of stroke-related neurologic deficits, and possibly other intangible effects of stroke regardless of deficits, which prevent survivors from returning to the workforce.Stroke survivors need more than just medications or limb or language rehabilitative services to resume life after stroke. A greater understanding of stroke-induced cognitive, psychosocial, and personality...

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Long-term increased risk of unemployment after young stroke

Cited by 79 publications

References 22 publications

Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry

Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry

Return to Paid Work after Ischemic Stroke in Patients Treated with Intravenous Thrombolysis

Life after stroke

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