title: Mexican Americans are Less Likely to Return to Work Following Stroke: Clinical and Policy Implications.
abstract: BACKGROUND
  Greater poststroke disability and U.S. employment policies may disadvantage minority stroke survivors from returning to work. We explored ethnic differences in return to work among Mexican Americans (MAs) and non-Hispanic whites (NHWs) working at the time of their stroke.
  
  
  METHODS
  Stroke patients were identified from the population-based BASIC (Brain Attack Surveillance in Corpus Christi) study from August 2011 to December 2013. Employment status was obtained at baseline and 90-day interviews. Sequential logistic regression models were built to assess ethnic differences in return to work after accounting for the following: (1) age (<65 versus ≥65); (2) sex; (3) 90-day National Institutes of Health Stroke Scale (NIHSS); and (4) education (lower than high school versus high school or higher).
  
  
  RESULTS
  Of the 729 MA and NHW stroke survivors who completed the baseline interview, 197 (27%) were working at the time of their stroke, of which 125 (63%) completed the 90-day outcome interview. Forty-nine (40%) stroke survivors returned to work by 90 days. MAs were less likely to return to work (OR = .45, 95% CI .22-.94) than NHWs. The ethnic difference became nonsignificant after adjusting for NIHSS (OR = .59, 95% CI .24-1.44) and further attenuated after adjusting for education (OR = .85, 95% CI .32- 2.22).
  
  
  CONCLUSIONS
  The majority of stroke survivors did not return to work within 90 days of their stroke. MA stroke survivors were less likely to return to work after stroke than NHW stroke survivors which was due to their greater neurological deficits and lower educational attainment compared with that of NHW stroke survivors. Future work should focus on clinical and policy efforts to reduce ethnic disparities in return to work.
authors.affiliation: Stroke Program, University of Michigan, Ann Arbor, Michigan. Electronic address: lerusche@umich.edu.
authors.forename: Lesli E
authors.initials: LE
authors.lastname: Skolarus
authors.affiliation: Department of Public Health, Grand Valley State University, Allendale, Michigan.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Wing
authors.affiliation: Stroke Program, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.affiliation: Stroke Program, University of Michigan, Ann Arbor, Michigan.
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
authors.affiliation: Stroke Program, University of Michigan, Ann Arbor, Michigan; Department of Epidemiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D011640:Public Policy; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology / Q000503:physiopathology; D017741:Survivors; D014481:United States / Q000453:epidemiology / Q000208:ethnology
keywords: Stroke; disparities; ethnicity; survivorship