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<h5 class="section-title" id="d2408699e155">BACKGROUND:</h5>
<p id="d2408699e157">Survivors of acute health events can experience lasting reductions
in functional status
and quality of life, as well as reduced ability to work and earn income. We aimed
to assess the effect of acute myocardial infarction (MI), cardiac arrest and stroke
on work and earning among working-age people.
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<h5 class="section-title" id="d2408699e160">METHODS:</h5>
<p id="d2408699e162">For this retrospective cohort study, we used the Canadian Hospitalization
and Taxation
Database, which contains linked hospital and income tax data, from 2005 to 2013 to
perform difference-in-difference analyses. We matched patients admitted to hospital
for acute MI, cardiac arrest or stroke with controls who were not admitted to hospital
for these indications. Participants were aged 40–61 years, worked in the 2 years before
the event and were alive 3 years after the event. Patients were matched to controls
for 11 variables. The primary outcome was working status 3 years postevent. We also
assessed earnings change attributable to the event. We matched 19 129 particpants
who were admitted to hospital with acute MI, 1043 with cardiac arrest and 4395 with
stroke to 1 820 644, 307 375 and 888 481 controls, respectively.
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<h5 class="section-title" id="d2408699e165">RESULTS:</h5>
<p id="d2408699e167">Fewer of the patients who were admitted to hospital were working
3 years postevent
than controls for acute MI (by 5.0 percentage points [pp], 95% confidence interval
[CI] 4.5–5.5), cardiac arrest (by 12.9 pp, 95% CI 10.4–15.3) and stroke (by 19.8 pp,
95% CI 18.5–23.5). Mean (95% CI) earnings declines attributable to the events were
$3834 (95% CI 3346–4323) for acute MI, $11 143 (95% CI 8962–13 324) for cardiac arrest,
and $13 278 (95% CI 12 301–14 255) for stroke. The effects on income were greater
for patients who had lower baseline earnings, comorbid disease, longer hospital length
of stay or needed mechanical ventilation. Sex, marital status or self-employment status
did not affect income declines.
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<h5 class="section-title" id="d2408699e170">INTERPRETATION:</h5>
<p id="d2408699e172">Acute MI, cardiac arrest and stroke all resulted in substantial
loss in employment
and earnings that persisted for at least 3 years after the events. These outcomes
have consequences for patients, families, employers and governments. Identification
of subgroups at high risk for these losses may assist in targeting interventions,
policies and legislation to promote return to work.
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