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.