大血管闭塞机械取栓后再就业的卒中患者中的性别差异。

Sex Disparities in Re-Employment in Stroke Patients With Large Vessel Occlusion Undergoing Mechanical Thrombectomy.

机构信息

Department of Neurology (M.H., S.G., E.H., M.M., K.G., T.U.), University Medical Center of the Johannes Gutenberg University Mainz, Germany.

Department of Neuroradiology (M.A.B.), University Medical Center of the Johannes Gutenberg University Mainz, Germany.

出版信息

Stroke. 2022 Aug;53(8):2528-2537. doi: 10.1161/STROKEAHA.121.037386. Epub 2022 Apr 21.

DOI:10.1161/STROKEAHA.121.037386

PMID:35443786

Abstract

BACKGROUND

Strokes in the working-age population represent a relevant share of ischemic strokes and re-employment is a major factor for well-being in these patients. Income differences by sex have been suspected a barrier for women in returning to paid work following ischemic stroke. We aim to identify predictors of (not) returning to paid work in patients with large vessel occlusion treated with mechanical thrombectomy (MT) to identify potential areas of targeted vocational rehabilitation.

METHODS

From 6635 patients enrolled in the German Stroke Registry Endovascular Treatment between 2015 and 2019, data of 606 patients of the working population who survived large vessel occlusion at least 90 days past MT were compared based on employment status at day 90 follow-up. Univariate analysis, multiple logistic regression and analyses of area under the curve were performed to identify predictors of re-employment.

RESULTS

We report 35.6% of patients being re-employed 3 months following MT (median age 54.0 years; 36.1% of men, 34.5% of women [=0.722]). We identified independent negative predictors against re-employment being female sex (odds ratio [OR], 0.427 [95% CI, 0.229-0.794]; =0.007), higher National Institutes of Health Stroke Scale (NIHSS) score 24 hours after MT (OR, 0.775 [95% CI, 0.705-0.852]; <0.001), large vessel occlusion due to large-artery atherosclerosis (OR, 0.558 [95% CI, 0.312-0.997]; =0.049) and longer hospital stay (OR, 0.930 [95% CI, 0.868-0.998]; =0.043). Positive predictors favoring re-employment were excellent functional outcome (modified Rankin Scale score of 0-1) at 90 day follow-up (OR, 11.335 [95% CI, 4.864-26.415]; <0.001) and combined treatment with intravenous thrombolysis (OR, 1.904 [95% CI, 1.046-3.466]; =0.035). Multiple regression modeling increased predictive power of re-employment status significantly over prediction by best single functional outcome parameter (National Institutes of Health Stroke Scale 24 hours after MT ≤5; : 0.582 versus 0.432; area under the receiver operating characteristic curve: 0.887 versus 0.835, <0.001).

CONCLUSIONS

There is more to re-employment after MT than functional outcome alone. In particular, attention should be paid to possible systemic barriers deterring women from resuming paid work.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03356392.

摘要

背景

在工作年龄段人群中，中风占缺血性中风的比例相当高，而重新就业是这些患者幸福的一个重要因素。性别导致的收入差异被怀疑是女性在经历缺血性中风后重返有偿工作的障碍。我们的目的是确定接受机械血栓切除术（MT）治疗的大血管闭塞患者（not）重返有偿工作的预测因素，以确定潜在的针对性职业康复领域。

方法

在 2015 年至 2019 年期间参加德国中风登记处血管内治疗的 6635 名患者中，我们根据 MT 后至少 90 天的随访时的就业状况，比较了 606 名工作年龄人群中幸存的大血管闭塞患者的数据。进行单变量分析、多变量逻辑回归和曲线下面积分析，以确定重新就业的预测因素。

结果

我们报告 MT 后 3 个月内有 35.6%的患者重新就业（中位年龄 54.0 岁；36.1%的男性，34.5%的女性[=0.722]）。我们发现独立的负预测因素包括女性性别（比值比[OR]，0.427[95%置信区间，0.229-0.794]；=0.007）、MT 后 24 小时 NIHSS 评分较高（OR，0.775[95%置信区间，0.705-0.852]；<0.001）、大血管闭塞由大动脉粥样硬化引起（OR，0.558[95%置信区间，0.312-0.997]；=0.049）和住院时间较长（OR，0.930[95%置信区间，0.868-0.998]；=0.043）。有利于重新就业的阳性预测因素是 90 天随访时的良好功能结局（改良 Rankin 量表评分为 0-1）（OR，11.335[95%置信区间，4.864-26.415]；<0.001）和静脉溶栓联合治疗（OR，1.904[95%置信区间，1.046-3.466]；=0.035）。多元回归模型显著提高了重新就业状态的预测能力，超过了最佳单一功能结局参数（MT 后 24 小时 NIHSS 评分≤5；：0.582 与 0.432；接受者操作特征曲线下面积：0.887 与 0.835，<0.001）。