Abstract
Objective: (1) To determine patterns of return to work (RTW) after traumatic brain injury and other causes of acquired brain injury (ABI) among young adults aged 19–30 years and (2) to compare the stability of long-term labor-market attachment (LMA) to the background population.Method: Nationwide registry-based inception cohort study of 10 years weekly data of employment status. Patients (n = 8,496) aged 19–30 years with first-ever diagnosis of TBI, stroke, subarachnoid hemorrhage, encephalopathy, brain tumor, or CNS infections during 1999–2015. For comparison, a general population cohort (n = 206,025) individually matched on age, sex, and municipality was identified. The main outcome was RTW, which was defined as time to LMA, i.e., a week without public assistance benefits except education grants/leave. Stable labor-market attachment (sLMA) was defined as LMA for at least 75% over 52 weeks. The cumulative incidence proportions of RTW and stable RTW in the ABI cohort were estimated with the Aalen-Johansen estimator with death as a competing event.Results: Twelve weeks after diagnosis 46.9% of ABI cohort had returned to stable RTW, which increased to 57.4% 1 year after, and 69.7% 10 years after. However, compared to controls fewer had sLMA 1 year (OR: 0.25 [95% CI 0.24–0.27]) and 10 years after diagnosis (OR: 0.35 [95% CI: 0.33–0.38]). Despite significant variations, sLMA was lower compared to the control cohort for all subtypes of ABI and no significant improvements were seen after 2–5 years.Conclusion: Despite relatively fast RTW only a minor proportion of young patients with ABI achieves sLMA.
Highlights
Acquired brain injury (ABI) is by definition an injury to the brain that is not hereditary, congenital, or degenerative, but acquired after birth
Twelve weeks after diagnosis 46.9% of ABI cohort had returned to stable return to work (RTW), which increased to 57.4% 1 year after, and 69.7% 10 years after
SLMA was lower compared to the control cohort for all subtypes of ABI and no significant improvements were seen after 2–5 years
Summary
Acquired brain injury (ABI) is by definition an injury to the brain that is not hereditary, congenital, or degenerative, but acquired after birth. ABI is among the most disabling conditions [2, 3] with potentially profound implications for the individual, family, and society, since it often leads to short- and long-term physical, communicative, cognitive, and emotional dysfunction. The capability to return to work (RTW) or resume education [4,5,6] may be reduced, since it is highly dependent of physical, cognitive, communicative, and emotional functioning. Young adults are often in the process of completing their educational achievements or are in the early stages of their careers. Since ABI may influence or even hamper the ability to complete education or maintain stable labor-market attachment (LMA), young adults may be a vulnerable group [5, 10]
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