Comparison of socio-economic and life satisfaction outcomes following a stroke or an injury in New Zealand

Abstract

Background: In New Zealand, people unable to work due to an illness may be eligible for a means-tested government benefit whereas injured people are eligible for a wide range of support including earnings-related compensation through the no-fault Accident Compensation Corporation (ACC). The aim of the study was to compare the effect of this difference on socio-economic and life satisfaction outcomes of individuals who experienced a stroke with those who had an injury, and their main informal carer.

Methods: A comparative cohort study was undertaken of individuals aged 18-64 years, who had a first-stroke (n=109). Participants were matched by age, sex, and functional impairment to injured individuals (n=429) participating in the Prospective Outcomes of Injury Study. Demographic, health, socio-economic, and life satisfaction data were collected by interview 3.5 and 12 months after stroke or injury. Logistic regression adjusting for the matching variables, and functional impairment at 12 months, was undertaken. A cross-sectional survey using a postal questionnaire was conducted with carers of individuals with a stroke (n=22) or an injury (n=65) who indicated that their independence was affected at 12 months and their main support person lived in the same household. Logistic regression, adjusting for age, sex, and the impairment level of the individual being cared for, was undertaken. Results: At 12 months after the stroke or injury, the odds of being back at work were 3.1 times greater for the Injury Group compared to the Stroke Group (OR 3.1; 95% CI 1.7-5.6). The Stroke Group exhibited significantly greater decline in their income over 12 months and the mean personal ($29,167) and household ($59,640) income in the Stroke Group was significantly lower than the Injury Group ($48,156 & $87,295 respectively). The decline in income was greater for those in both groups who had a higher income initially, and for those who had not returned to work. The odds of reporting low standard of living (OR=0.64; 95% CI 0.39-1.0), and income insufficiency (OR=0.52; 95% CI 0.34-0.81), were less for the Injury Group. Greater out-of-pocket expenses were reported by the Stroke Group. For both Groups, life satisfaction decreased at 3.5 months and increased again by 12 months, but not to the pre-event level, except for those in the Stroke Group with a ‘Low’ income pre-event whose life satisfaction declined and did not recover. The informal carers of individuals with a stroke showed consistently poorer work, cost, economic, and well-being outcomes compared to Injury Carers, but the small sample size precluded statistically significant differences from being observed. Conclusion: This is the first study to empirically measure outcomes that occur as a consequence of the different financial and social support systems for illness and injury in New Zealand. While it is possible that unknown confounders, or residual confounding, partly explain the difference between groups, the extra financial and rehabilitative support available through ACC are likely to be the main factors influencing these outcomes. This study has implications for government policy to review the financial and rehabilitation support that is provided to people after an illness to protect them against greater decline in their socio-economic status.