Women less likely to return to work after severe stroke, new study finds

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Marianne Hahn (Credit: Markus Schmidt)

According to new research published in Stroke, about one third of people who had a severe ischaemic stroke—and underwent a mechanical thrombectomy to remove their large-vessel blood clot—resumed work three months after stroke treatment. In addition, women were about half as likely to return to work after a severe stroke compared to men in 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,” said lead study author Marianne Hahn (Johannes Gutenberg University, Mainz, Germany). “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.”

Researchers examined data from the German Stroke Registry—Endovascular Treatment Study Group. The analysis included more than 600 patients (28% women), aged 18 to 64 years, who had a large-vessel ischaemic stroke between 2015 and 2019. All study participants were employed prior to their stroke and were treated with mechanical thrombectomy, while more than half of the study participants also received intravenous thrombolysis.

Researchers compared the people who returned to work 90 days after being treated with mechanical thrombectomy to those who did not resume work. After accounting for age, sex, health conditions, type and severity of stroke, and treatment characteristics, the analysis found:

  • About one third of the stroke survivors resumed work three months later.
  • The amount of persistent functional deficits after stroke was the main reason people were not able to return to work.
  • Women were 58% less likely to return to work three months after mechanical thrombectomy compared to men.
  • Individuals who were treated with both mechanical thrombectomy and intravenous thrombolysis were almost twice as likely to return to work compared to the individuals who had undergone mechanical thrombectomy only.

“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 non-smokers and were more likely to have no existing significant disability when discharged from the hospital compared to the men in our study,” Hahn added. “Despite having more of these favourable characteristics for return to work, we did not observe a higher reemployment rate among women before considering these differences.”

The researchers note further study is needed to explain the discrepancy between men and women re-entering the workforce after a major stroke. More intensive and supportive vocational rehabilitation programmes may be valuable to help women return to work, they state.

“There is more to reemployment after mechanical thrombectomy than functional outcomes,” Hahn continued. “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 wellbeing, self-esteem and life satisfaction.”

The study authors believe their findings may be transferrable to other countries with similar healthcare and rehabilitation systems. However, confirmation and in-depth analyses of national policies are necessary to explain the observation—since there may be differences, such as social services and benefits, which have been shown to influence return to work.

The study was also limited, they note, in that the data lacked detailed information about types of jobs and available employment opportunities. The German Stroke Registry does not include social determinants of health, and whether an individual was reemployed at the same job, or working full- or part-time. The researchers claim these limitations may help explain and play a role in whether people returned to work after a severe stroke.


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