Original Article| Volume 24, ISSUE 8, P1715-1723, August 2015

Use of Stroke-Related Income Supplements and Predictors of Use in a Working-Aged Finnish Ischemic Stroke Cohort


      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.


      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.


      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.


      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.

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        • Johnston S.C.
        • Mendis S.
        • Mathers C.D.
        Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modeling.
        Lancet Neurol. 2009; 8: 345-354
        • Brown D.L.
        • Boden-Albala B.
        • Langa K.M.
        • et al.
        Projected costs of ischemic stroke in the United States.
        Neurology. 2006; 67: 1390-1395
        • Joo H.
        • George M.G.
        • Fang J.
        • et al.
        A literature review of indirect costs associated with stroke.
        J Stroke Cerebrovasc Dis. 2014; 23: 1753-1763
        • Daniel K.
        • Wolfe C.D.A.
        • Busch M.A.
        • et al.
        What are the social consequences of stroke for working-aged adults? A systematic review.
        Stroke. 2009; 40: e431-e440
        • Treger I.
        • Shames J.
        • Giaquinto S.
        • et al.
        Return to work in stroke patients.
        Disabil Rehabil. 2007; 17: 1397-1403
        • Kauranen T.
        • Turunen K.
        • Laari S.
        • et al.
        The severity of cognitive deficits predicts return to work after a first-ever ischaemic stroke.
        J Neurol Neurosurg Psychiatry. 2013; 84: 316-321
        • Adams Jr., H.P.
        • Bendixen B.H.
        • Kappelle L.J.
        • et al.
        Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment.
        Stroke. 1993; 24: 35-41
        • Goldstein L.B.
        • Bertels C.
        • Davis J.N.
        Interrater reliability of the NIH Stroke Scale.
        Arch Neurol. 1989; 46: 660-662
        • Mahoney F.I.
        • Barthel D.
        Functional evaluation: the Barthel Index.
        Maryland State Med J. 1965; 14: 56-61
        • Reitan R.M.
        Validity of the trail making test as an indication of organic brain damage.
        Percept Motor Skill. 1958; 8: 271-276
      1. Poutiainen E. Kalska H. Laasonen M. Trail-Making-Testi. Käsikirja. (The Trail-Making Test. A Finnish Manual.). Psykologien Kustannus Oy, Helsinki2010
        • Christensen A.L.
        Luria's Neuropsychological Investigation Text.
        2nd ed. Munksgaard, Copenhagen1979
        • Lezak M.D.
        • Howieson D.B.
        • Loring D.W.
        Neuropsychological Assessment.
        4th ed. Oxford University Press, New York2004
        • Carlesimo G.A.
        • Fadda L.
        • Caltagirone C.
        Basic mechanisms of constructional apraxia in unilateral brain-damaged patients: Role of visuo-perceptual and executive disorders.
        J Clin Exp Neuropsychol. 1993; 15: 342-358
        • De Renzi E.
        • Faglioni P.
        Normative data and screening power of a shortened version of the Token Test.
        Cortex. 1978; 14: 41-49
        • Wechsler D.
        WMS-R Käsikirja. (The WMS-R. A Finnish Manual).
        Psykologien Kustannus Oy, Helsinki1996
        • Benton A.L.
        Revised visual retention test.
        4th ed. Psychological Corporation, New York1974
        • Wechsler D.
        WAIS-III Käsikirja. (The WAIS-III. A Finnish Manual).
        Psykologien Kustannus Oy, Helsinki2005
        • Laine M.
        • Niemi J.
        • Koivuselkä-Sallinen P.
        • et al.
        BDAT- Bostonin diagnostinen afasiatesti. (Standardized Finnish version of the Boston Diagnostic Aphasia Examination).
        Psykologien Kustannus Oy, Helsinki1997
        • Adunsky A.
        • Fleissig Y.
        • Levenkrohn S.
        • et al.
        Clock drawing task, mini-mental state examination and cognitive-functional independence measure: relation to functional outcome of stroke patients.
        Arch Gerontol Geriatr. 2002; 35: 153-160
        • Vilkki J.
        Hemi-inattention in visual search for parallel lines after focal cerebral lesions.
        J Clin Exp Neuropsychol. 1989; 11: 319-331
        • McNair D.M.
        • Lorr M.
        An analysis of mood in neurotics.
        J Abnorm Soc Psychol. 1964; 69: 620-627
        • Sheehan D.V.
        • Harnett-Sheehan K.
        • Raj B.A.
        The measurement of disability.
        Clin Psychopharmacol. 1996; 11: 89-95
        • Lamassa M.
        • Di Carlo A.
        • Pracucci G.
        • et al.
        Characteristics, outcome, and care of stroke associated with atrial fibrillation in Europe: Data from a multicenter multinational hospital-based registry (The European Community Stroke Project).
        Stroke. 2001; 32: 392-398
        • Wolf P.A.
        • Abbott R.D.
        • Kannel W.B.
        Atrial fibrillation as an independent risk factor for stroke: the Framingham study.
        Stroke. 1991; 22: 983-988
        • Nys G.M.
        • van Zandvoort M.J.
        • de Kort P.L.
        • et al.
        The prognostic value of domain-specific cognitive abilities in acute first-ever stroke.
        Neurology. 2005; 64: 821-827
        • Nys G.M.
        • van Zandvoort M.J.
        • van der Worp H.B.
        • et al.
        Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke.
        J Neurol Sci. 2006; 247: 149-156