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The Association between Stroke, Integrated Stroke Systems, and the Employability and Productivity of Canadian Stroke Survivors

Background: Integrated stroke systems have been associated with reduced disability in stroke survivors, but their impact on employability and productivity (hours worked/week and hourly wages) of stroke survivors is unclear. Methods: We used Canadian Community Health Surveys (2000–2014) to conduct a quasi-experimental study with the aim of determining the impact of stroke on employability and productivity, and whether the implementation of integrated stroke systems was associated with improvements in the employability and productivity of adult Canadian stroke survivors. Multivariable generalized Poisson regression models were used to determine the effect of stroke on employability; multivariable Heckman models were used to estimate the effect of stroke on productivity. A difference in differences analysis was used to determine the impact of stroke systems on the primary outcomes. Results: The study sample included 400,797 respondents, of whom 5,786 (1.4%) were stroke survivors. Compared to the general population, stroke survivors were less likely to be employed (adjusted incidence rate ratio 0.62, 95% CI 0.59–0.66) and earned an hourly wage that was 5.3% lower (95% CI 1.1–9.3) and worked an average of 1.9 fewer hours per week (95% CI 0.9–2.9). Over the study period, the employability of stroke survivors improved but not productivity. After accounting for temporal changes in overall employment, there was no association between the implementation of integrated stroke systems and either employability or productivity. Conclusion: Employability of stroke survivors improved over the study period but remained lower than the general population, with no differences in provinces with and without integrated stroke systems.