Women less likely than men to return to work after large vessel occlusion stroke
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Women were less likely to return to work after large vessel occlusion stroke compared with men, despite similar 90-day functional outcomes, according to study findings published in Stroke.
Other predictors of not returning to work after large vessel occlusion stroke included elevated NIH Stroke Scale score after mechanical thrombectomy, large vessel occlusion due to large-artery atherosclerosis and longer hospital stay.
Both men and women were more likely to return to work if stroke was treated with combined mechanical thrombectomy and IV thrombolysis compared with mechanical thrombectomy alone, according to the study.
“Returning to work after a severe stroke is a sign of successful rehabilitation. Resuming pre-stroke levels of daily living and activities is highly associated with a better quality of life,” Marianne Hahn, MD, clinician scientist in the department of neurology at Johannes Gutenberg University in Mainz, Germany, said in a press release. “In contrast to most return-to-work studies, we included a large cohort of only people treated with mechanical clot removal; they are a subgroup of stroke patients at high risk for severe, persisting deficits.”
For the present analysis, researchers utilized data from the German Stroke Registry – Endovascular Treatment from 2015 to 2019 to identify 606 patients of the working population who survived at least 90 days after mechanical thrombectomy for large vessel occlusion stroke. Participants were compared to identify predictors of return to work after stroke treatment.
Participants were excluded if they were older than 64 years at baseline, died by 90 days or were retired, unemployed or a student before stroke.
Negative predictors of returning to work
Researchers observed that 35.6% of patients had returned to work by 90 days after mechanical thrombectomy for stroke (median age, 54 years).
Men who underwent mechanical thrombectomy were more often older (55 vs. 52 years; P < .001), more likely to smoke (39.6% vs. 29.9%; P = .029) and more likely to experience large artery atherosclerosis-associated stroke (38.8% vs. 22.2%; P < .001) compared with women in the cohort.
The absolute proportion of patients who returned to work after mechanical thrombectomy did not differ between men and women (P = .722). According to the study, more women achieved excellent functional outcome by discharge compared with men (48.1% vs. 37.1%; P = .015), and researchers observed no sex differences in functional outcome at 90 days.
Independent negative predictors of 90-day return to work included:
- female sex (OR = 0.427; 95% CI, 0.229-0.794; P = .007);
- higher NIH Stroke Scale score 24 hours after mechanical thrombectomy (OR = 0.775; 95% CI, 0.705-0.852; P < .001);
- large vessel occlusion due to large-artery atherosclerosis (OR = 0.558; 95% CI, 0.312-0.997; P = .049); and
- longer hospital stay (OR per day = 0.93; 95% CI, 0.868-0.998; P = .043).
“After examining the data further, we also found that women in our cohort were younger at the time of their stroke, were more likely to be nonsmokers and were more likely to have no existing significant disability when discharged from the hospital compared to the men in our study,” Hahn said in the release. “Despite having more of these favorable characteristics for return to work, we did not observe a higher reemployment rate among women before considering these differences.”
Positive predictors of returning to work
Positive predictors of 90-day return to work included modified Rankin Scale score of 0 to 1 at 90 days (OR = 11.335; 95% CI, 4.864-26.415; P < .001) and combined treatment with IV thrombolysis (OR = 1.904; 95% CI, 1.046-3.466; P = .035).
“There is more to reemployment after mechanical thrombectomy than functional outcomes,” Hahn said in the release. “Targeted vocational and workplace rehabilitation interventions have been shown to improve rates of return to work. And previous studies have also found that returning to work is associated with increased well-being, self-esteem and life satisfaction.”
Reference:
- Women were less likely to return to work after a severe stroke, new study finds. newsroom.heart.org/news/women-were-less-likely-to-return-to-work-after-a-severe-stroke-new-study-finds. Published April 21, 2022. Accessed April 21, 2022.
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