Labour market participation and retirement after stroke in Denmark: registry based cohort study

Abstract

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.

Fig 1

Weekly prevalences of labour market participation, sick leave, receipt of a disability pension, voluntary early retirement, receipt of a state pension, and death among patients with ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage and among individuals from the general population matched by age, sex, and calendar year

Fig 2

Prevalence of labour market participation two years after ischaemic stroke and propensity score weighted differences and ratios compared with individuals from the general population matched by age, sex, and calendar year, in patient subgroups. Propensity score weights calculated based on the following covariates: age (omitted when stratifying by this variable), sex (omitted when stratifying by this variable), calendar period (omitted when stratifying by this variable), labour market participation at four weeks before the index date (omitted when stratifying by this variable), income level (omitted when stratifying by this variable), education level (omitted when stratifying by this variable), hypertension, dyslipidaemia, ischaemic heart disease, atrial fibrillation or flutter, valvular heart disease, heart failure, peripheral artery disease, venous thromboembolism, diabetes, thyroid disorder, gout, chronic pulmonary disease, allergy, ulcer/chronic gastritis, chronic liver disease, inflammatory bowel disease, diverticular disease of intestine, chronic kidney disease, prostate disorders, connective tissue disorders, osteoporosis, painful conditions, HIV/AIDS, anaemias, cancers, vision problems, hearing problems, migraine, epilepsy, Parkinson’s disease, multiple sclerosis, neuropathies, organic disorders, substance abuse, schizophrenia, mood disorders, neurotic disorders, eating disorders, personality disorders, intellectual disabilities, developmental disorders, behavioural disorders, anticoagulants, antiplatelets, statins, proton pump inhibitors, antipsychotic drugs, number of non-psychiatric comorbidities (omitted when stratifying by this variable), and number of psychiatric comorbidities (omitted when stratifying by this variable). PS=propensity score