Return to work after ischemic stroke in young adults: A registry-based follow-up study

Affiliations

¹ From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden. karoliina.aarnio@helsinki.fi.
² From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 30315074
PMCID: PMC6260196
DOI: 10.1212/WNL.0000000000006510

Return to work after ischemic stroke in young adults: A registry-based follow-up study

Karoliina Aarnio et al. Neurology. 2018.

. 2018 Nov 13;91(20):e1909-e1917.

doi: 10.1212/WNL.0000000000006510. Epub 2018 Oct 12.

Affiliations

¹ From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden. karoliina.aarnio@helsinki.fi.
² From Clinical Neurosciences (K.A., J.B., L.T., E.H., M.K., T.T., J.P.), Neurology, University of Helsinki and Department of Neurology, Helsinki University Hospital; Department of Neurology (J.R.-P.), Helsinki University Hospital, Finland; Department of Neurology (J.R.-P.), La Paz University Hospital, Madrid, Spain; Center for Stroke Research Berlin (B.S., J.H.), Institute of Biometry and Clinical Epidemiology (J.H.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin Germany; Berlin Institute of Health (BIH) (J.H.), Berlin, Germany. Clinical Research Unit (CRU) (J.H.), Berlin Institute of Health (BIH), Berlin, Germany; Department of Clinical Neuroscience (T.T.), Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg; and Department of Neurology (T.T.), Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 30315074
PMCID: PMC6260196
DOI: 10.1212/WNL.0000000000006510

Abstract

Objective: We aimed to investigate the proportion of young patients not returning to work (NRTW) at 1 year after ischemic stroke (IS) and during follow-up, and clinical factors associated with NRTW.

Methods: Patients from the Helsinki Young Stroke Registry with an IS occurring in the years 1994-2007, who were at paid employment within 1 year before IS, and with NIH Stroke Scale score ≤15 points at hospital discharge, were included. Data on periods of payment came from the Finnish Centre for Pensions, and death data from Statistics Finland. Multivariate logistic regression analyses assessed factors associated with NRTW 1 year after IS, and lasagna plots visualized the proportion of patients returning to work over time.

Results: We included a total of 769 patients, of whom 289 (37.6%) were not working at 1 year, 323 (42.0%) at 2 years, and 361 (46.9%) at 5 years from IS. When adjusted for age, sex, socioeconomic status, and NIH Stroke Scale score at admission, factors associated with NRTW at 1 year after IS were large anterior strokes, strokes caused by large artery atherosclerosis, high-risk sources of cardioembolism, and rare causes other than dissection compared with undetermined cause, moderate to severe aphasia vs no aphasia, mild and moderate to severe limb paresis vs no paresis, and moderate to severe visual field deficit vs no deficit.

Conclusions: NRTW is a frequent adverse outcome after IS in young adults with mild to moderate IS. Clinical variables available during acute hospitalization may allow prediction of NRTW.

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Figures

**Figure 1. Flowchart of patients included in the study**
NIHSS = NIH Stroke Scale.

**Figure 2. Lasagna plots on employment trajectories over time after ischemic stroke**
(A) Initial lasagna plot: employment trajectories for patients with ischemic stroke 1 to 15 years after stroke. (B) Multiply within-column sorted lasagna plot: employment trajectories for patients with ischemic stroke 1 to 15 years after stroke. (C) Multiply within-column sorted lasagna plot stratified for sex: employment trajectories for patients with ischemic stroke 1 to 15 years after stroke. (D) Multiply within-column sorted lasagna plot stratified for age groups (15–34, 35–49): employment trajectories for patients with ischemic stroke 1 to 15 years after stroke.

See this image and copyright information in PMC

Comment in

Return to work in young adults with stroke: Another catastrophe in a catastrophic disease.
Ameriso SF. Ameriso SF. Neurology. 2018 Nov 13;91(20):905-906. doi: 10.1212/WNL.0000000000006495. Epub 2018 Oct 12. Neurology. 2018. PMID: 30315073 No abstract available.

References

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Return to work after ischemic stroke in young adults: A registry-based follow-up study

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Return to work after ischemic stroke in young adults: A registry-based follow-up study

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