title: Long-term increased risk of unemployment after young stroke: a long-term follow-up study.
abstract: OBJECTIVE
  To investigate the prevalence, excess risk, and risk factors of unemployment in patients after a TIA, ischemic stroke, or intracerebral hemorrhage at ages 18 through 50 years, compared with nationwide controls.
  
  
  METHODS
  We performed a hospital-based cohort study among 694 patients, aged 18-50 years, with a first-ever TIA, ischemic stroke, or intracerebral hemorrhage. After a mean follow-up duration of 8.1 (SD 7.7) years, we used logistic regression analysis to calculate odds ratio (OR) with 95% confidence interval (CI) for being unemployed as a young stroke patient, compared with the Dutch population of vocational age (n = 7,803,000), with subsequent assessment of risk factors of unemployment.
  
  
  RESULTS
  Young stroke patients had a higher risk of being unemployed than their peers in the Dutch population: women OR 2.3 (1.8-2.9), men OR 3.2 (2.5-4.0). A higher NIH Stroke Scale score at admission (OR 1.1 [95% CI 1.0-1.1]) and a longer follow-up duration (middle tertile OR 2.8 [95% CI 1.7-4.7], upper tertile OR 3.4 [95% CI 1.9-6.1]) were associated with a higher risk of being unemployed.
  
  
  CONCLUSIONS
  Young stroke patients had a 2-3 times higher risk of unemployment after 8 years of follow-up. Return-to-work programs should be developed, adjusted, and evaluated in order to diminish the negative effects that unemployment can have on patients' life satisfaction and to limit the socioeconomic consequences.
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Noortje A M M
authors.initials: NA
authors.lastname: Maaijwee
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Loes C A
authors.initials: LC
authors.lastname: Rutten-Jacobs
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Renate M
authors.initials: RM
authors.lastname: Arntz
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Schaapsmeerders
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Hennie C
authors.initials: HC
authors.lastname: Schoonderwaldt
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
authors.forename: Ewoud J
authors.initials: EJ
authors.lastname: van Dijk
authors.affiliation: From the Department of Neurology, Centre for Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Centre, the Netherlands. L.C.A.R.-J. is currently with the Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK. FrankErik.deLeeuw@radboudumc.nl.
authors.forename: Frank-Erik
authors.initials: FE
authors.lastname: de Leeuw
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062707:Return to Work; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013997:Time Factors; D014478:Unemployment / Q000706:statistics & numerical data*; D055815:Young Adult