Stroke survivors average a 31% drop in income

Survivors of heart attack, stroke and cardiac arrest are not only less likely to maintain a job following those events, but their earnings might take a significant hit even if they stay employed, researchers reported Jan. 7 in the Canadian Medical Association Journal.

The results were especially dire for stroke survivors, who were found to be 19.8 percent less likely to be employed three years postevent compared to other individuals of their same age, sex, pre-event earnings range and province of residency. Their average earnings were $13,278 lower at that three-year timepoint, expressed in 2012 Canadian dollars. Mean earnings losses tied to cardiac arrest and acute myocardial infarction (MI) were $11,143 and $3,834, respectively, reflecting that stroke and cardiac arrest typically cause a greater degree of disability compared to a heart attack.

Overall, annual income dropped 31.2 percent among stroke survivors, 22.8 percent among cardiac arrest survivors and 8.1 percent among MI survivors.

“These losses were not limited to those who became unable to work; those working in the third postevent year had earnings decrements of 5 [percent]–20 [percent],” wrote lead author Allan Garland, MD, with the University of Manitoba, and colleagues. “The earnings losses were well-established by the first year postevent and changed little to the third postevent year, creating a widening gap in cumulative earnings between those who had and had not had these health events.”

Returning to work after these experiences has been shown to be positive for employees’ self-esteem and quality of life. And maintaining the same earnings from before could prevent problems such as failing to take medications or foregoing medical checkups due to cost issues, which could lead to even poorer health, Garland et al. noted. Lost productivity in the workforce exacts a societal cost as well, with governments and employers shouldering some of that burden.

“Our study provides high-quality data needed for accurate, bottom-up calculations of the cumulative economic consequences of these common health events,” the authors wrote. “In addition, our identification of high-risk subgroups may assist in targeting interventions, policies and legislation to promote return to work, which itself is associated with well-being and life satisfaction among those having these health events.”

The researchers used the Canadian Hospitalization and Taxation Database to compare patients who were admitted for acute MI, cardiac arrest or stroke to control individuals who weren’t hospitalized for those conditions but were well-matched in terms of age, sex, total earnings, marital status and place of residency including the specific province and urban/rural status.

The final study sample included 19,129 MI survivors, more than 1,000 cardiac arrest survivors and 4,395 stroke survivors who were alive three years after their event, plus more than 3 million individuals who comprised the control cohort.

Patients with more comorbidities and those who required mechanical ventilation or longer initial hospital stays were found to have the steepest drops in income.

Total earnings suffered more among higher-paid participants, but the proportion of the salary decline was greater among those with lower baseline earnings. For example, stroke survivors in the lowest third of salary earned 43.4 percent less three years postevent, while top-third earners experienced income drops of 26.4 percent. The trend was similar for MI, with income declines of 13.4 and 6.4 percent, respectively, among the lowest- and highest-paid employees.

However, the authors were quick to point out their results may not be generalizable to other countries, although the themes of lost productivity and lower quality of life are probably ubiquitous for health-related income declines.

“National differences in social supports including health, disability and unemployment insurance may substantially influence labor market responses of individuals to illness and injury,” they wrote. “Because these effects differ by health event and possibly by country, much work remains to form a more complete understanding of how acute illnesses influence labor market outcomes.”