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

ObjectiveTo document the impact of stroke on employment income among people employed at the time of stroke.DesignPopulation-based cohort study.ParticipantsPeople hospitalized for stroke in Ontario, Canada (2010–2014) and people without stroke matched on demographic characteristics.Main measuresRobust 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.ResultsStroke 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.ConclusionsIt 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.