title: Use of Stroke-Related Income Supplements and Predictors of Use in a Working-Aged Finnish Ischemic Stroke Cohort.
abstract: BACKGROUND
  Compared with the direct costs, the indirect costs of stroke may be larger contributors to the socioeconomic burden of stroke, and the need to better understand the indirect costs of stroke is well established. We investigated the indirect costs of stroke according to a novel outcome, the use of stroke-related income supplements, in a Finnish cohort of working-aged patients.
  
  
  METHODS
  Consecutive patients (n = 230) who experienced a first-ever ischemic stroke were recruited. Demographic, clinical, and cognitive function data (which were measured using clinical neuropsychological assessments) were collected at baseline and at 6-month and 2-year follow-ups. Data on the use of income supplements within the first 3 years of the stroke were retrieved from national insurance registry files and used to construct survival models.
  
  
  RESULTS
  Stroke patients used a mean of 11 months of stroke-related income supplements; this use was associated with atrial fibrillation, cognitive impairment, prestroke income supplement use, higher National Institutes of Health Stroke Scale scores, lower Barthel Index scores, and increased lesion sizes. In multivariate survival models, atrial fibrillation and cognitive impairment were the factors most strongly associated with the use of stroke-related income supplements.
  
  
  CONCLUSIONS
  Using stroke-related income supplement data to quantify poststroke productivity losses allowed a working-aged cohort to be investigated without inclusion restrictions based on occupational status or other factors; the use of these data as an outcome emphasized the well-known detrimental effects of atrial fibrillation and cognitive impairment on stroke outcome. The results support stroke-related income supplement use as a complementary outcome for understanding stroke-related productivity losses.
authors.affiliation: Institute of Behavioural Sciences, Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland; Department of Neurology and Clinical Neurophysiology, Lapland Central Hospital, Rovaniemi, Finland. Electronic address: tatu.kauranen@lshp.fi.
authors.forename: Tatu
authors.initials: T
authors.lastname: Kauranen
authors.affiliation: Institute of Behavioural Sciences, Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland; Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Siiri
authors.initials: S
authors.lastname: Laari
authors.affiliation: Institute of Behavioural Sciences, Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland; Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Turunen
authors.affiliation: Laakso Hospital, Department of Social Services and Health Care, City of Helsinki, Finland.
authors.forename: Marjatta
authors.initials: M
authors.lastname: Melkas
authors.affiliation: Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Mustanoja
authors.affiliation: Department of Neurology and Clinical Neurophysiology, Lapland Central Hospital, Rovaniemi, Finland.
authors.forename: Peter
authors.initials: P
authors.lastname: Baumann
authors.affiliation: Institute of Behavioural Sciences, Faculty of Behavioural Sciences, University of Helsinki, Helsinki, Finland; Clinical Neurosciences, Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Erja
authors.initials: E
authors.lastname: Poutiainen
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000150:complications; D003072:Cognition Disorders / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D009483:Neuropsychological Tests; D018709:Statistics, Nonparametric; D020521:Stroke / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology; D011795:Surveys and Questionnaires
keywords: Ischemic stroke; atrial fibrillation; cognitive impairment; indirect costs; neuropsychology; productivity losses