gms | German Medical Science

Introduction: Several lines of evidence suggest a rising incidence of ischemic stroke (IS) among young and middle-aged adults, resulting in an increased prevalence of young stroke survivors in the community [1], [2]. Return to vocational activities is among the most important aims of health care after stroke at younger ages [3], and several predictors for this return have been investigated [4], [5], [6]. The Helsinki Young Stroke Registry (HYSR) included all consecutive first-ever IS patients aged 15-49 and treated at Helsinki University Central Hospital (HUCH) between January 1994 and May 2007 [7]^. The objective of this study was to analyse the proportion of patients that had not returned to work (NRTW), factors associated with NRTW at one year after stroke and trajectories of employment status during a follow-up period of up to 5 years.

Methods: Data on periods of payment and sick leaves until 2012 were acquired from the Finnish Centre for Pensions and Social Insurance Institution of Finland and were linked to the registry data based on the unique social security number. HYSR patients at paid employment within 1 year before stroke were included. Factors associated with NRTW at 1 year after stroke were analysed with multivariate logistic regression models. Trajectories of employment status during follow-up time were visualized using lasagna plots [8], an application of sequence analysis [9] that lends itself well to display e.g. trajectories of disease progression or remission during follow-up in epidemiologic studies.

Results: A total of 769 patients were at paid employment within one year before stroke, of whom 289 (37.6%) had not returned to work (NRTW) one year later. In a multivariate regression model adjusted for age, sex, smoking, type 2 diabetes, heavy drinking, and NIH Stroke Scale score at admission, NRTW was significantly associated with blue-collar worker status (OR 2.65 vs. upper white-collar workers; 95%CI 1.36-5.15), large-artery atherosclerosis (OR 2.97; 95%CI 1.32-6.66) or rare causes underlying stroke (OR 1.91; 95%CI 1.04-3.52), both vs. undetermined causes, large anterior stroke (OR 2.43; 95% CI 1.23-4.78), and symptoms at discharge: mild (OR 2.09; 95%CI 1.23-3.57) or moderate to severe (OR 5.95; 95%CI 2.79-12.69) vs. no limb paresis, moderate to severe aphasia (OR 2.46 vs. no aphasia; 95%CI 1.07-5.63), and moderate to severe visual field deficit (OR 2.27 vs. no deficit; 95%CI 1.09-4.73).

Discussion: NRTW is a frequent outcome after ischemic stroke at a younger age. Clinical variables available during acute hospitalization may allow prediction of those patients at a high risk of NRTW and so may help to target rehabilitation more effectively. The proportion of NRTW is comparable to other studies with different age- and stroke definitions [3]^, [4]^, [5].

Data linkage of registry and secondary data and using sequence analyses allow analysing trajectories during long-time follow-up with clinical disease parameters as predictors. Lasagna plots with different sorting strategies of the data will be presented at the conference.

Die Autoren geben an, dass kein Interessenkonflikt besteht.

Die Autoren geben an, dass ein positives Ethikvotum vorliegt.

The abstract has been submitted with a different focus and in a different format to the European Stroke Organization Conference 2017 in Prague, May 16th-18th, 2017 (www.esoc2017.com)