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Health insurance utilisation after ischaemic stroke in Sweden: a retrospective cohort study in a system of universal healthcare and social insurance
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden .
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Goteborg, Sweden.
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden; Quantify Research, Stockholm, Sweden.
Örebro University, School of Medical Sciences.ORCID iD: 0000-0002-3845-8100
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2021 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 3, article id e043826Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Stroke is one of the largest single-condition sources of the global burden of non-communicable disease in terms of disability-adjusted life-years and monetary costs, directly as well as indirectly in terms of informal care and productivity loss. The objective was to assess the population afflicted with ischaemic stroke in working age in the context of universal healthcare and social insurance; to estimate the levels of absence from work, the indirect costs related to that and to assess the associated patient characteristics.

METHODS: This was a retrospective register-based study; all individuals registered with an ischaemic stroke during 2008-2011 in seven Swedish regions, covering the largest cities as well as more rural areas, were included. Individual-level data were used to compute net days of sick leave and disability pension, indirect costs due to productivity loss and to perform regression analysis on net absence from work to assess the associated factors. Costs related to productivity loss were estimated using the human capital approach.

RESULTS: Women had significantly fewer net days of sick leave and disability pension than men after multivariable adjustment, and high-income groups had higher levels of sick leave than low-income groups. There were no significant differences for participants regarding educational level, region of birth or civil status. Indirect monetary costs amounted to €17 400 per stroke case during the first year, totalling approximately €169 million in Sweden.

CONCLUSION: The individual's burden of stroke is heavy in terms of morbidity, and the related productivity loss for society is immense. Income-group differences point to a socioeconomic gradient in the utilisation of the Swedish social insurance.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2021. Vol. 11, no 3, article id e043826
Keywords [en]
Health economics, public health, stroke
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:oru:diva-90760DOI: 10.1136/bmjopen-2020-043826ISI: 000634886700030PubMedID: 33762236Scopus ID: 2-s2.0-85103277656OAI: oai:DiVA.org:oru-90760DiVA, id: diva2:1540065
Funder
Swedish Research Council, VR2017-00946Swedish Heart Lung FoundationThe Swedish Brain Foundation
Note

Funding Agencies:

Promobilia Foundation  

Norrbacka-Eugenia Foundation  

Swedish government ALFGBG-718711

Swedish county councils, the ALF agreement ALFGBG-718711

Available from: 2021-03-26 Created: 2021-03-26 Last updated: 2024-01-02Bibliographically approved

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