Economic well-being after stroke: differences by age of onset.

BACKGROUND Stroke is a leading cause of long-term disability in the United States. Little is known about the broader economic consequences of stroke across the life course.

METHODS We examined data from the Medical Expenditure Panel Survey (MEPS) (2020-2022) to explore differences in labor force participation, hours worked, and income among those with no history of stroke, young stroke (<age 50) and old stroke (≥age 50). Generalized linear models (GLMs) were used adjusting for demographic and health-related heterogeneity. Robustness checks were conducted by stratifying the models by age and retirement status. Two-part models were used to account for the semicontinuous distribution of income and work hours, and all models adjusted for demographic, socioeconomic, and health-related covariates.

RESULTS We found that stroke survivors exhibited significantly worse economic outcomes. Young stroke survivors had 44% lower odds of labor force participation (OR = 0.56, 95% CI: 0.41 to 0.77), worked 4.83 fewer hours per week (95% CI: -8.43 to -1.24), and earned $9,776 less annually (95% CI: -$14,416 to -$5,136). Older stroke survivors also had 69% lower odds of labor force part+icipation (OR = 0.31, 95% CI: 0.22 to 0.42), work fewer hours (-11.90 hours/week, 95% CI: -15.04 to -8.76), and had significantly lower income (-$7,761, 95% CI: -$12,729 to -$2,794). Results remained robust across stratified models. Other significant predictors of economic disadvantage included public or no insurance, female gender, lower educational attainment, and a higher comorbidity burden.

CONCLUSIONS We conclude that stroke has profound and persistent economic consequences across the life course regardless of age.