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Published in: BMC Public Health 1/2011

Open Access 01-12-2011 | Research article

Income and education as predictors of return to working life among younger stroke patients

Authors: Sven Trygged, Kozma Ahacic, Ingemar Kåreholt

Published in: BMC Public Health | Issue 1/2011

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Abstract

Background

Socioeconomic conditions are not only related to poor health outcomes, they also contribute to the chances of recovery from stroke. This study examines whether income and education were predictors of return to work after a first stroke among persons aged 40-59.

Methods

All first-stroke survivors aged 40-59 who were discharged from a hospital in 1996-2000 and who had received income from work during the year prior to the stroke were sampled from the Swedish national register of in-patient care (n = 7,081). Income and education variables were included in hazard regressions, modelling the probability of returning to work from one to four years after discharge. Adjustments for age, sex, stroke subtype, and length of in-patient care were included in the models.

Results

Both higher income and higher education were associated with higher probability of returning to work. While the association between education and return to work was attenuated by income, individuals with university education were 13 percent more likely to return than those who had completed only compulsory education, and individuals in the highest income quartile were about twice as likely to return as those in the lowest. The association between socioeconomic position and return to work was similar for different stroke subtypes. Income differences between men and women also accounted for women's lower probability of returning to work.

Conclusions

The study demonstrates that education and income were independent predictors of returning to work among stroke patients during the first post-stroke years. Taking the relative risk of return to work among those in the higher socioeconomic positions as the benchmark, there may be considerable room for improvement among patients in lower socioeconomic strata.
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Literature
1.
go back to reference Feigin V, Lawes C, Bennett D, Anderson C: Stroke epidemiology: a review of population based studies of incidence, prevalence, and case fatality in the late 20th century. Lancet Neurol. 2003, 2: 43-53. 10.1016/S1474-4422(03)00266-7.CrossRefPubMed Feigin V, Lawes C, Bennett D, Anderson C: Stroke epidemiology: a review of population based studies of incidence, prevalence, and case fatality in the late 20th century. Lancet Neurol. 2003, 2: 43-53. 10.1016/S1474-4422(03)00266-7.CrossRefPubMed
2.
go back to reference Feigin V, Lawes C, Bennett D, Barker-Collo S, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009, 8: 355-69. 10.1016/S1474-4422(09)70025-0.CrossRefPubMed Feigin V, Lawes C, Bennett D, Barker-Collo S, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol. 2009, 8: 355-69. 10.1016/S1474-4422(09)70025-0.CrossRefPubMed
3.
go back to reference Asplund K: What MONICA told us about stroke. Lancet Neurol. 2005, 4: 64-68. 10.1016/S1474-4422(04)00967-6.CrossRefPubMed Asplund K: What MONICA told us about stroke. Lancet Neurol. 2005, 4: 64-68. 10.1016/S1474-4422(04)00967-6.CrossRefPubMed
6.
go back to reference Daniel K, Wolfe CD, Busch MA, McKevitt C: What are the social consequences of stroke for working-aged adults? A systematic review. Stroke. 2009, 6: 431-40.CrossRef Daniel K, Wolfe CD, Busch MA, McKevitt C: What are the social consequences of stroke for working-aged adults? A systematic review. Stroke. 2009, 6: 431-40.CrossRef
7.
go back to reference Wozniak M, Kittner S: Return to work after ischemic stroke: A methodological review. Neuroepidemiology. 2002, 21: 159-166. 10.1159/000059516.CrossRefPubMed Wozniak M, Kittner S: Return to work after ischemic stroke: A methodological review. Neuroepidemiology. 2002, 21: 159-166. 10.1159/000059516.CrossRefPubMed
8.
go back to reference Treger I, Shames J, Giaquinto S, Ring H: Return to work in stroke patients. Disabil Rehabil. 2007, 29: 1397-1403. 10.1080/09638280701314923.CrossRefPubMed Treger I, Shames J, Giaquinto S, Ring H: Return to work in stroke patients. Disabil Rehabil. 2007, 29: 1397-1403. 10.1080/09638280701314923.CrossRefPubMed
9.
go back to reference Cox A, McKevitt C, Rudd A, Wolfe C: Socioeconomic status and stroke. Lancet Neurol. 2006, 5: 181-188. 10.1016/S1474-4422(06)70351-9.CrossRefPubMed Cox A, McKevitt C, Rudd A, Wolfe C: Socioeconomic status and stroke. Lancet Neurol. 2006, 5: 181-188. 10.1016/S1474-4422(06)70351-9.CrossRefPubMed
11.
go back to reference Li C, Hedblad B, Rosvall M, Buchwald F, Khan FA, Engström G: Stroke incidence, recurrence, and case-fatality in relation to socioeconomic position. A population-based study of middle-aged Swedish men and women. Stroke. 2008, 39: 2191-2196. 10.1161/STROKEAHA.107.507756.CrossRefPubMed Li C, Hedblad B, Rosvall M, Buchwald F, Khan FA, Engström G: Stroke incidence, recurrence, and case-fatality in relation to socioeconomic position. A population-based study of middle-aged Swedish men and women. Stroke. 2008, 39: 2191-2196. 10.1161/STROKEAHA.107.507756.CrossRefPubMed
12.
go back to reference Kuper H, Adami H-O, Theorell T, Weiderpass E: The socioeconomic gradient in the incidence of stroke: A prospective study in middle-aged women in Sweden. Stroke. 2007, 38: 27-33.CrossRefPubMed Kuper H, Adami H-O, Theorell T, Weiderpass E: The socioeconomic gradient in the incidence of stroke: A prospective study in middle-aged women in Sweden. Stroke. 2007, 38: 27-33.CrossRefPubMed
13.
go back to reference Jakovljevi D, Sarti C, Sivenius J, Torppa J, Mähönen M, Immonen-Räihä P, Kaarsalo E, Alhainen K, Kuulasmaa K, Tuomilehto J, Puska P, Salomaa V: Socioeconomic status and ischemic stroke. Stroke. 2001, 32: 1492-1498. 10.1161/01.STR.32.7.1492.CrossRef Jakovljevi D, Sarti C, Sivenius J, Torppa J, Mähönen M, Immonen-Räihä P, Kaarsalo E, Alhainen K, Kuulasmaa K, Tuomilehto J, Puska P, Salomaa V: Socioeconomic status and ischemic stroke. Stroke. 2001, 32: 1492-1498. 10.1161/01.STR.32.7.1492.CrossRef
14.
go back to reference Howard G, Till JS, Toole J, Matthews C, Truscott BL: Factors influencing return to work following cerebral infarction. JAMA. 1985, 11: 226-232.CrossRef Howard G, Till JS, Toole J, Matthews C, Truscott BL: Factors influencing return to work following cerebral infarction. JAMA. 1985, 11: 226-232.CrossRef
15.
go back to reference Vestling M, Tufvesson B, Iwarsson S: Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med. 2003, 35: 127-131. 10.1080/16501970310010475.CrossRefPubMed Vestling M, Tufvesson B, Iwarsson S: Indicators for return to work after stroke and the importance of work for subjective well-being and life satisfaction. J Rehabil Med. 2003, 35: 127-131. 10.1080/16501970310010475.CrossRefPubMed
16.
go back to reference Bergmann H, Küthmann M, von Ungern-Sternberg A, Weimann VG: Medical educational and functional determinants of employment after stroke. J Neural Transm Suppl. 1991, 33: 157-61.PubMed Bergmann H, Küthmann M, von Ungern-Sternberg A, Weimann VG: Medical educational and functional determinants of employment after stroke. J Neural Transm Suppl. 1991, 33: 157-61.PubMed
17.
go back to reference Neau JP, Ingrand P, Mouille-Brachet C, Rosier MP, Couderq C, Alvarez A, Gil R: Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis. 1998, 8: 296-302. 10.1159/000015869.CrossRefPubMed Neau JP, Ingrand P, Mouille-Brachet C, Rosier MP, Couderq C, Alvarez A, Gil R: Functional recovery and social outcome after cerebral infarction in young adults. Cerebrovasc Dis. 1998, 8: 296-302. 10.1159/000015869.CrossRefPubMed
18.
go back to reference Wozniak MA, Kittner SJ, Price TR, Hebel JR, Sloan MA, Gardner JF: Stroke location is not associated with return to work after first ischemic stroke. Stroke. 1999, 30: ;2568-2573. 10.1161/01.STR.30.12.2568.CrossRefPubMed Wozniak MA, Kittner SJ, Price TR, Hebel JR, Sloan MA, Gardner JF: Stroke location is not associated with return to work after first ischemic stroke. Stroke. 1999, 30: ;2568-2573. 10.1161/01.STR.30.12.2568.CrossRefPubMed
19.
go back to reference Weisbroth S, Esibill N, Zuger RR: Factors in the vocational success of hemiplegic patients. Archives of physical medicine and rehabilitation. 1971, 52: 441-446.PubMed Weisbroth S, Esibill N, Zuger RR: Factors in the vocational success of hemiplegic patients. Archives of physical medicine and rehabilitation. 1971, 52: 441-446.PubMed
20.
go back to reference Saeki S, Toyonaga T: Determinants of early return to work after first stroke in Japan. J Rehabil Med. 2010, 42: 254-258. 10.2340/16501977-0503.CrossRefPubMed Saeki S, Toyonaga T: Determinants of early return to work after first stroke in Japan. J Rehabil Med. 2010, 42: 254-258. 10.2340/16501977-0503.CrossRefPubMed
21.
go back to reference Saeki S, Ogata H, Okubo T, Takahashi K, Hoshuyama T: Return to work after stroke: A follow-up study. Stroke. 1995, 26: 399-401. 10.1161/01.STR.26.3.399.CrossRefPubMed Saeki S, Ogata H, Okubo T, Takahashi K, Hoshuyama T: Return to work after stroke: A follow-up study. Stroke. 1995, 26: 399-401. 10.1161/01.STR.26.3.399.CrossRefPubMed
22.
go back to reference Busch MA, Coshall C, Heuschmann PU, McKevitt C, Wolfe CDA: Sociodemographic differences in return to work after stroke - the South London Stroke Register (SLSR). J Neurol Neurosurg Psychiatry. 2009, 80: 888-893. 10.1136/jnnp.2008.163295.CrossRefPubMed Busch MA, Coshall C, Heuschmann PU, McKevitt C, Wolfe CDA: Sociodemographic differences in return to work after stroke - the South London Stroke Register (SLSR). J Neurol Neurosurg Psychiatry. 2009, 80: 888-893. 10.1136/jnnp.2008.163295.CrossRefPubMed
23.
go back to reference Glozier N, Hacket ML, Parag V, Anderson CS: The Influence of Psychiatric Morbidity on Return to Paid Work After Stroke in Younger Adults: The Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke. 2008, 39: 1526-1532. 10.1161/STROKEAHA.107.503219.CrossRefPubMed Glozier N, Hacket ML, Parag V, Anderson CS: The Influence of Psychiatric Morbidity on Return to Paid Work After Stroke in Younger Adults: The Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke. 2008, 39: 1526-1532. 10.1161/STROKEAHA.107.503219.CrossRefPubMed
24.
go back to reference Saeki S, Ogata H, Okubo T, Takahashi K, Hoshuyama T: Factors influencing return to work after stroke in Japan. Stroke. 1993, 24: 1182-1185. 10.1161/01.STR.24.8.1182.CrossRefPubMed Saeki S, Ogata H, Okubo T, Takahashi K, Hoshuyama T: Factors influencing return to work after stroke in Japan. Stroke. 1993, 24: 1182-1185. 10.1161/01.STR.24.8.1182.CrossRefPubMed
25.
go back to reference Torssander J, Erikson R: Stratification and mortality - A comparison of education, class, status, and income. Eur Sociol Review. 2010, 26: 465-474. 10.1093/esr/jcp034.CrossRef Torssander J, Erikson R: Stratification and mortality - A comparison of education, class, status, and income. Eur Sociol Review. 2010, 26: 465-474. 10.1093/esr/jcp034.CrossRef
26.
go back to reference Stoltenberg C, Skov P: Determinants of return to work after long-term sickness absence in six Danish municipalities. Scand J Public Health. 2010, 38: 299-308. 10.1177/1403494809357095.CrossRefPubMed Stoltenberg C, Skov P: Determinants of return to work after long-term sickness absence in six Danish municipalities. Scand J Public Health. 2010, 38: 299-308. 10.1177/1403494809357095.CrossRefPubMed
27.
go back to reference Rohwer G: Techniques of Event History Modeling: New approaches to causal analysis. 2002, Mahwah, NJ: Lawrence Erlbaum Rohwer G: Techniques of Event History Modeling: New approaches to causal analysis. 2002, Mahwah, NJ: Lawrence Erlbaum
28.
go back to reference Lindström B, Röding J, Sundelin G: Positive attitudes and preserved level of motor performance are important factors for return to work in younger persons after stroke: A national survey. J Rehabil Med. 2009, 41: 714-718. 10.2340/16501977-0423.CrossRefPubMed Lindström B, Röding J, Sundelin G: Positive attitudes and preserved level of motor performance are important factors for return to work in younger persons after stroke: A national survey. J Rehabil Med. 2009, 41: 714-718. 10.2340/16501977-0423.CrossRefPubMed
29.
go back to reference Avendaño M, Kunst AE, Huisman M, van Lenthe F, Bopp M, Borrell C, Valkonen T, Regidor E, Costa G, Donkin A, Borgan J-K, Deboosere P, Gadeyne S, Spadea T, Andersen O, Mackenbach JP: Educational Level and Stroke Mortality. A comparison of 10 European populations during the 1990s. Stroke. 2004, 35: 432-437. 10.1161/01.STR.0000109225.11509.EE.CrossRefPubMed Avendaño M, Kunst AE, Huisman M, van Lenthe F, Bopp M, Borrell C, Valkonen T, Regidor E, Costa G, Donkin A, Borgan J-K, Deboosere P, Gadeyne S, Spadea T, Andersen O, Mackenbach JP: Educational Level and Stroke Mortality. A comparison of 10 European populations during the 1990s. Stroke. 2004, 35: 432-437. 10.1161/01.STR.0000109225.11509.EE.CrossRefPubMed
30.
go back to reference Kapral MK, Wang H, Mamdani M, Tu JV: Effect of socioeconomic status on treatment and mortality after stroke. Stroke. 2002, 33: 268-10.1161/hs0102.101169.CrossRefPubMed Kapral MK, Wang H, Mamdani M, Tu JV: Effect of socioeconomic status on treatment and mortality after stroke. Stroke. 2002, 33: 268-10.1161/hs0102.101169.CrossRefPubMed
31.
go back to reference Rodriguez J, Exposito JA, Salvador J, Ferrand P, Perez JC, del Pino R: Recuperación funcional y reincorporación sociolaboral en el paciente joven tras un ictus. (Functional recovery and return to work in the young patient after a stroke. Published in Spanish). Neurologia. 2004, 19: 160-167.PubMed Rodriguez J, Exposito JA, Salvador J, Ferrand P, Perez JC, del Pino R: Recuperación funcional y reincorporación sociolaboral en el paciente joven tras un ictus. (Functional recovery and return to work in the young patient after a stroke. Published in Spanish). Neurologia. 2004, 19: 160-167.PubMed
32.
go back to reference Löfmark U, Hammarström A: Evidence for age-dependent education-related differences in men and women with first-ever stroke. Neuroepidemiology. 2008, 31: 21-27.CrossRefPubMed Löfmark U, Hammarström A: Evidence for age-dependent education-related differences in men and women with first-ever stroke. Neuroepidemiology. 2008, 31: 21-27.CrossRefPubMed
33.
go back to reference Hetemaa T, Manderbacka K, Reunanen A, Koskinen S, Keskimäki I: Socioeconomic inequities in invasive cardiac procedures among patients with incident angina pectoris or myocardial infarction. Scand J Public Health. 2006, 34: 116-23. 10.1080/14034940510032248.CrossRefPubMed Hetemaa T, Manderbacka K, Reunanen A, Koskinen S, Keskimäki I: Socioeconomic inequities in invasive cardiac procedures among patients with incident angina pectoris or myocardial infarction. Scand J Public Health. 2006, 34: 116-23. 10.1080/14034940510032248.CrossRefPubMed
34.
go back to reference de Haan R, Limburg M, van der Meulen J, van den Bos GA: Use of health care services after stroke. Qual Health Care. 1993, 4: 222-227.CrossRef de Haan R, Limburg M, van der Meulen J, van den Bos GA: Use of health care services after stroke. Qual Health Care. 1993, 4: 222-227.CrossRef
35.
go back to reference Wilkinson R, Pickett K: The spirit level: Why Greater Equality Makes Societies Stronger. 2009, London: Penguin books Wilkinson R, Pickett K: The spirit level: Why Greater Equality Makes Societies Stronger. 2009, London: Penguin books
36.
go back to reference Le Grand C, Szulkin R, Tåhlin M: Education and inequality in Sweden: A literature review. Education and Wage Inequality in Europe: A literature review. Edited by: Asplund R, Barth E. 2005, Helsinki: ETLA, Series B212, 321-360. Le Grand C, Szulkin R, Tåhlin M: Education and inequality in Sweden: A literature review. Education and Wage Inequality in Europe: A literature review. Edited by: Asplund R, Barth E. 2005, Helsinki: ETLA, Series B212, 321-360.
37.
go back to reference van Doorslaer E, Masseria C, Koolman X: Inequalities in access to medical care by income in developed countries. CMAJ. 2006, 174 (2): 177-183. 10.1503/cmaj.050584.CrossRefPubMedPubMedCentral van Doorslaer E, Masseria C, Koolman X: Inequalities in access to medical care by income in developed countries. CMAJ. 2006, 174 (2): 177-183. 10.1503/cmaj.050584.CrossRefPubMedPubMedCentral
38.
go back to reference Link BG, Phelan J: Social conditions as fundamental causes of disease. J Health Soc Behav. 1995, 80-94. Extra issue Link BG, Phelan J: Social conditions as fundamental causes of disease. J Health Soc Behav. 1995, 80-94. Extra issue
Metadata
Title
Income and education as predictors of return to working life among younger stroke patients
Authors
Sven Trygged
Kozma Ahacic
Ingemar Kåreholt
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2011
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-11-742

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