Stroke among people of working age : from a public health and working life perspective

Abstract: Background: Stroke is a major cause of serious disability and death. In Sweden approximately 30,000 people suffer from stroke each year, and 20% of them are under 65 years of age.Aim: The aim of this thesis was to study stroke among people aged 30-65 years. Specific aims were: a) to compare the incidence of stroke in Sweden between the periods 1989-1991 and 1998-2000 in persons aged 30-65 years, b) to explore sick leave, disability pension and health-care-seeking behaviour among people 30-65 years of age prior to their stroke in year 2001 in the county of Östergötland, Sweden, c) to explore whether organisational change and work-related stress, as measured by the Job Content Questionnaire, was associated with first-ever stroke among working people aged 30-65, d) to describe the experience of return to work (RTW) after stroke from the patient’s perspective in comparison with experiences of patients on long-term sick leave.Material and methods: Studies I and II are based on retrospective register data. Study I is based on data from the SHDR and the CDR during 1989-2000, and NSR Östergötland during the period 1989-2000. Study II is based on data from the HCDWÖ and the social insurance office. Study III is a case–control study where the cases are obtained from four hospitals in the south-east of Sweden and the controls come from the base populations at each respective hospital. Studies IV and V are qualitative studies and the informants in study IV are cases from Linköping and Norrköping included in study III. Study V is a case study based upon a focus group interview with 7 women who had undergone a problem-based rehabilitation.Results: Stroke incidence increased in Sweden for both men and women between 1989 and 2000, especially for women. Future stroke patients showed more sick leave compared with the general population. For men, accumulated sick leave of more than 29 days was associated with an increased risk of later stroke. Frequent health-care-seeking behaviour is not a tool for identifying women who develop stroke, while it may be an indicator for men. We found partial support for an association between organisational change, work-related stress and stroke. The likelihood of stroke was significantly lower for people in active job situations. The individual stroke patient’s capacity and ability to return to work was perceived as enhanced by motivation or ‘will’ and self-efficacy, in combination with external support. Self-efficacy was not only a personal trait or internal factor; it was enhanced and encouraged in interaction with contextual conditions. When the more medically oriented rehabilitation is finished, other aspects of the individual’s abilities should be in focus. There seem to be similarities between the RTW process and processes of health promotion.Conclusion: Stroke among younger people in regard to work related risk factors and work related rehabilitation is a field where few studies have been carried out, and further research is needed in order to investigate risk factors and planning for prevention, health promotion and rehabilitation. The thesis also indicates the need for gender-specific studies.