Return to work is an important outcome factor for working-age patients poststroke. Previous epidemiological studies on this topic have been small (on average 125 patients per study). Their estimated effects are therefore associated with a tremendous statistical uncertainty. The present study estimates the effect of various predictors on the odds of returning to work after stroke in the total population of 20–57-year-old previously employed hospital treated patients with stroke in Denmark 1996–2006 (N=19 985).
Methods and results
The patients were followed through national registers; 62% were gainfully occupied 2 years after stroke. The odds of returning to work were higher among people with intracerebral infarction, OR 1.0 (the reference group), than they were among people with subarachnoid haemorrhage, OR 0.79 (95% CI 0.71 to 0.88), and intracerebral haemorrhage, OR 0.39 (0.35 to 0.43). The odds of returning to work were lower among workers in elementary occupations OR 1.0 (reference group) than they were among workers in occupations that require skills at a basic level, OR 1.50 (1.38 to 1.64), technicians and associate professionals, OR 2.33 (2.05 to 2.65) and professionals, OR 3.04 (2.70 to 3.43). Patients in municipalities with a brain-injury rehabilitation centre did not have a better prognosis than patients in other municipalities, OR 0.91 (0.78 to 1.06). Being a woman, OR 0.79 (0.74 to 0.84), self-employed, OR 0.87 (0.78 to 0.96), or ≥50 years, OR 0.61 (0.57 to 0.65), was associated with an adverse prognosis.
Further research is needed to explain the gender inequality, which suggests either a potential to improve return-to-work rates among the females or a tendency among the males to return too early.
The present study estimates ORs for return to gainful occupation ca. 2 years after stroke.
It focuses on clinical, demographic and occupational factors which are potentially useful in predicting return to work.
The study includes the total population of 20–57-year-old previously employed hospital treated patients with stroke in Denmark 1996–2006.
62% of the studied patients were gainfully occupied during the second calendar year after the stroke.
The odds of returning to work depend on age, gender, occupation, self-employment and type of stroke.
Women had a much lower chance of returning to work than men, and to our knowledge there are no known physiological factors which can justify this difference.
Patients in municipalities with a brain-injury rehabilitation centre did not have a better prognosis than patients in other municipalities.
Strengths and limitations of this study
The follow-up was carried out through registers and all people in the target population were included. Hence, the study is free from sampling bias, recall bias and non-response bias.
The statistical model was completely defined, and a detailed study protocol was published before we looked at any relation between the concerned exposure and response variables in our data material. Since we adhered to the protocol, the study is free from hindsight bias.
The study is further strengthened by its size.
The major weakness of the study is that it does not contain any stroke-severity measures.