Prevalence and Factors Associated with Sick Leave After Stroke: A Long-term Registry-Based Case-Control Study in Sweden

Abstract Background: The increasing incidence of stroke among working-age adults leads to long-term disabilities, contributing to prolonged sick leave and imposing substantial societal and economic burdens. This study aimed to examine the trajectory of sick leave among working-age stroke cases, spanning from 1 year before to 3 years after the event, and to compare these patterns with matched controls. It also sought to identify factors associated with prolonged sick leave after stroke. Methods: This registry-based, retrospective longitudinal study utilized data from a local and a registry in Gothenburg, Sweden. Individuals aged 18–65 years with a first-ever stroke who survived at least 30 days after the event (2014–2019) were identified. Each case was matched 1:4 by age and sex with controls provided by Statistics Sweden database. Data on sick leave lasting ≥ 14 days were obtained from the Swedish Social Insurance Agency register. Statistical analyses included descriptive and comparative statistics, visualization of sick leave trajectories, and multivariable linear regression. Results: A total of 1,502 cases with a first-ever stroke and 6,008 matched controls were included. The mean age at stroke was 54.3 years, and 65.8% were men. The proportion of stroke cases on sick leave was consistently higher than that of controls throughout the entire follow-up period. Stroke cases had approximately 2.5 times more pre-stroke sick leave than their matched controls during the same period (50.7% of cases versus 19.7% of controls) and received more often sick leave compensation for cardiovascular, mental, and endocrine or metabolic disorders. Longer pre-stroke sick leave, intracerebral hemorrhage, impaired oral communication ability, dominant or both hands deficits, and increased fall risk were factors associated with prolonged post-stroke sick leave, explaining approximately 17% of the variance. Conclusions: Working-age individuals with stroke had at least two-fold higher need for sick leave compensation prior to their stroke, as well as a significantly more persistent sick leave burden after the event. These findings indicate that multiple aspects of underlying health vulnerabilities need to be taken into account during the post-stroke rehabilitation phase.