German Study Finds Women Were Less Likely to Return to Work After a Severe Stroke

April 21, 2022—The American Heart Association (AHA) announced the publication of new research showing that approximately one-third of patients who had a large vessel ischemic stroke treated with mechanical clot removal resumed work 3 months after stroke treatment. However, investigators also found that women were approximately half as likely to return to work after a severe stroke compared to men.

“Sex Disparities in Re-Employment in Stroke Patients With Large Vessel Occlusion Undergoing Mechanical Thrombectomy” by Marianne Hahn, MD, et al on behalf of the German Stroke Registry—Endovascular Treatment (GSR-ET) Study Group was published online ahead of print in Stroke.

As summarized by the AHA, the GSR-ET Study Group investigators examined data from the GRS-ET Study Group. The analysis included > 600 men and women (28% women) aged 18 to 64 years who had a large vessel ischemic stroke between 2015 and 2019.

All study participants were employed before their stroke and were treated with mechanical thrombectomy. More than half of the study participants also received intravenous thrombolysis.

The investigators compared the patients 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 the following, as outlined in the AHA press release:

• Approximately one-third of the stroke survivors resumed work 3 months after the event.
• The main reason patients were not able to return to work was the amount of persistent functional deficits after stroke.
• Women were 58% less likely to return to work 3 months after mechanical thrombectomy compared to men.
• Patients who were treated with both mechanical thrombectomy and intravenous thrombolysis were approximately twice as likely to return to work compared to the individuals who had undergone mechanical thrombectomy only.

“Returning to work after a severe stroke is a sign of successful rehabilitation,” commented Dr. Hahn, the study’s lead author, in the AHA press release. “Resuming prestroke levels of daily living and activities is highly associated with a better quality of life. 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.”

Dr. Hahn continued, “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. Despite having more of these favorable characteristics for return to work, we did not observe a higher re-employment rate among women before considering these differences.” Dr. Hahn is a clinician-scientist in the Department of Neurology at Johannes Gutenberg University in Mainz, Germany.

The investigators advised that 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 programs may be valuable to help women return to work.

“There is more to re-employment after mechanical thrombectomy than functional outcomes,” stated Dr. Hahn. “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.”

According to the AHA, the study investigators believe their findings may be transferable to other countries with similar health care 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.

Limitations of the study include 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 re-employed at the same job or working full- or part-time. These limitations may help explain and play a role in whether people returned to work after a severe stroke, advised the investigators in the AHA press release.