A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996–2006
- 1National Research Centre for the Working Environment, Copenhagen, Denmark
- 2Centre of Rehabilitation of Brain Injury, Copenhagen, Denmark
- Correspondence to Dr Harald Hannerz;
- Received 13 May 2011
- Accepted 19 July 2011
- Published 17 October 2011
Background 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.
Conclusion 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.
Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).
To cite: Hannerz H, Holbæk Pedersen B, Poulsen OM, et al. A nationwide prospective cohort study on return to gainful occupation after stroke in Denmark 1996–2006. BMJ Open 2011;1:e000180. doi:10.1136/bmjopen-2011-000180
Funding The study was funded by The Danish National Labour Market Authority, grant number 2008-5231.
Competing interests FH is Director of the Centre for Rehabilitation of Brain Injury (CRBI) in Copenhagen, Denmark. CRBI is a self-owned fund that is financially supported by grants from the Danish municipalities and, to a lesser degree, by a collectively bargained framework agreement under the Danish Health Law that covers 20% of the funds' operation costs. Since the study could tell us whether or not patients with stroke in municipalities with brain-injury rehabilitation centres have a better prognosis than those in other municipalities, there was a potential conflict of interest. We believe, however, that any potential bias owing to competing interests was eliminated by the publication of our detailed study protocol, which implied a commitment to adhere to the methods chosen and to publish the results regardless of the outcome.
Contributors LLA, OMP and FH initiated the project and acquired the funding. LLA, OMP and HH designed the study. HH performed the statistical analysis. HH and BHP prepared the first draft of the manuscript. All authors contributed to a critical revision of the manuscript.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The study was based on national registers. Questions regarding the usage of these registers should be addressed to Statistics Denmark.
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