Factors Associated with Return to Work After Ischemic Stroke in Young Adults in Northwest China: A retrospective study

Stroke increasingly affects working-age individuals. Returning to work (RTW) is a critical rehabilitation goal for these patients. This study investigated the proportion of young adults in Northwest China who did not return to work (NRTW) 12 months after an ischemic stroke and identified factors associated with NRTW.

We conducted a retrospective analysis of young patients (18-49 years) with ischemic stroke, admitted between January 2017 to August 2019, who had stable employment before onset. Data collected included demographics, lifestyle, comorbidities, stroke etiology classification, clinical features (including NIHSS score and specific functional impairments at admission) and medical interventions. RTW status was determined at the 12-month follow-up. Missing data were handled using multiple imputation by chained equations (20 imputed datasets). Univariable and multivariable logistic regressions were applied to identify factors associated with NRTW.

Among 339 previously employed patients (median age 44; 284 [83.78%] males), 106 (31.3%) had not returned to work at 12 months. Multivariable analysis identified female (OR = 3.02, 95% CI 1.21-7.52, P = 0.017) and pre-stroke manual labor (OR = 4.66, 95% CI 2.50-8.66, P < 0.001) as significant demographic factors positively associated with NRTW. A higher NIHSS score at admission was associated with NRTW (NIHSS 5-9 vs. 0-4: OR = 3.12, 95% CI 1.46-6.69, P = 0.003; NIHSS ≥ 10 vs. 0-4: OR = 6.69, 95% CI 2.35-19.04, P < 0.001). Regarding specific impairments, aphasia was significantly associated with NRTW (OR = 3.67, 95% CI 1.32-10.20, P = 0.013), while motor dysfunction showed a marginal positive association (OR = 1.83, 95% CI 0.99-3.35, P = 0.052). Cardioembolic stroke showed significant association in the model including specific clinical features (OR = 4.12, 95% CI 1.36-12.46, P = 0.012, Model 2), a finding that requires confirmation in larger studies.

A proportion of young stroke survivors in Northwest China do not resume work at 12 months after stroke. Key factors associated with failure to RTW include female sex, pre-stroke manual labor, greater stroke severity (higher NIHSS), and the presence of aphasia. Motor dysfunction may also be an important factor in RTW. The association of stroke etiology with RTW may be influenced by neurological severity. These findings highlight the need for targeted interventions to improve RTW outcomes in this population.