Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Goteborg, Sweden.
BMJ Open. 2021 Mar 24;11(3):e043826. doi: 10.1136/bmjopen-2020-043826.
Stroke is one of the largest single-condition sources of the global burden of non-communicable disease in terms of disability-adjusted life-years and monetary costs, directly as well as indirectly in terms of informal care and productivity loss. The objective was to assess the population afflicted with ischaemic stroke in working age in the context of universal healthcare and social insurance; to estimate the levels of absence from work, the indirect costs related to that and to assess the associated patient characteristics.
This was a retrospective register-based study; all individuals registered with an ischaemic stroke during 2008-2011 in seven Swedish regions, covering the largest cities as well as more rural areas, were included. Individual-level data were used to compute net days of sick leave and disability pension, indirect costs due to productivity loss and to perform regression analysis on net absence from work to assess the associated factors. Costs related to productivity loss were estimated using the human capital approach.
Women had significantly fewer net days of sick leave and disability pension than men after multivariable adjustment, and high-income groups had higher levels of sick leave than low-income groups. There were no significant differences for participants regarding educational level, region of birth or civil status. Indirect monetary costs amounted to €17 400 per stroke case during the first year, totalling approximately €169 million in Sweden.
The individual's burden of stroke is heavy in terms of morbidity, and the related productivity loss for society is immense. Income-group differences point to a socioeconomic gradient in the utilisation of the Swedish social insurance.
在伤残调整生命年和货币成本方面，脑卒中是导致非传染性疾病全球负担的最大单一病因之一，无论是直接原因还是间接原因，包括非正式护理和生产力损失。本研究的目的是评估在全民医保和社会保险的背景下，处于工作年龄的缺血性脑卒中患者人群；评估工作缺勤水平、相关间接成本，并评估相关患者特征。
这是一项回顾性基于登记的研究；在 2008 年至 2011 年期间，7 个瑞典地区的所有登记有缺血性脑卒中的患者均被纳入研究，这些地区涵盖了最大的城市和更多的农村地区。利用个体水平数据来计算病假和残疾抚恤金净天数、因生产力损失导致的间接成本，并对工作缺勤进行回归分析，以评估相关因素。使用人力资本法估计生产力损失相关成本。
经过多变量调整后，女性的病假和残疾抚恤金净天数明显少于男性，高收入组的病假天数高于低收入组。参与者的教育水平、出生地或婚姻状况没有显著差异。在第一年，每个脑卒中患者的间接货币成本为 17400 欧元，在瑞典总计约为 1.69 亿欧元。
脑卒中患者的个体疾病负担严重，对社会的生产力损失巨大。收入组差异表明，瑞典社会保险的利用存在社会经济梯度。
