The impact of stroke on employment income: A cohort study using hospital and income tax data in Ontario, Canada

Abstract

Objective: To document the impact of stroke on employment income among people employed at the time of stroke. Design: Population-based cohort study. Participants: People hospitalized for stroke in Ontario, Canada (2010–2014) and people without stroke matched on demographic characteristics. Main measures: Robust Poisson regression to estimate the effects of stroke on the probability of reporting employment income on tax returns over 3 years. Quantile regression difference-in-differences to estimate the changes in annual employment income attributable to stroke. Results: Stroke survivors were increasingly less likely to report any employment income poststroke, incidence rate ratios (IRR) 0.87 at 1 year (95% confidence intervals [CI]; 0.85–0.88), 0.82 at 2 years (95% CI; 0.81–0.84) and 0.81 at 3 years (95% CI; 0.79–0.82). IRR for reporting at least 50% of prestroke income levels were 0.76 at 1 year (95% CI; 0.75–0.78), 0.75 at 2 years (95% CI; 0.73–0.77) and 0.73 at 3 years (95% CI; 0.71–0.75). IRR for reporting at least 90% of prestroke income levels were 0.72 at 1 year (95% CI; 0.70–0.74), 0.66 at 2 years (95% CI; 0.64–0.68) and again 0.66 at 3 years (95% CI; 0.64–0.68). Relative changes in annual employment income attributable to stroke varied from a decrease of 13.8% (95% CI; 8.7–18.9) at the 75th income percentile to a decrease of 43.1% (95% CI; 18.7–67.6) at the 25th income percentile. Conclusions: It is important for healthcare and service providers to recognize the impact of stroke on return to prestroke levels of employment income. Low-income stroke survivors experience a more drastic loss in employment income and may need additional social support.