Ethnic Inequalities in Return to Work Post First Stroke: Findings From a Population‐Based Cohort Study in South London

Background Return to work post stroke is affected by sociodemographic factors and disability. We explored ethnic differences in employment among White, Black African, Black Caribbean, and other ethnic minority groups at 1 and 5 years post first stroke in a population‐based cohort. Methods Data on individuals with first‐ever stroke were obtained from the South London Stroke Register ([SLSR] patients registered between 1995 and 2025). Analysis was restricted to individuals in employment at the time of first stroke (N=1737, 67% men, mean age: 54 years [SD: 12.1]), with employment status assessed at 1 year and 5 years follow‐up. Associations between ethnicity and employment status (employed, retired or other) were examined using multinomial logistic regression adjusting for a range of sociodemographic (age, sex, study period, socioeconomic deprivation) and clinical factors (eg, stroke severity and management, co‐occurring health conditions, functional indicators) at baseline and follow‐up. Results After adjusting for baseline factors (socioeconomic deprivation/stroke severity/health conditions), Black African (relative risk ratio [RRR] 0.47 [95% CI 0.29–0.75]) and Black Caribbean (RRR, 0.40, [0.22–0.75]) groups were significantly less likely to be employed at 1 year post stroke than White individuals. At 5 years, only Black African individuals were less likely to be employed (RRR, 0.59 [95% CI, 0.30–1.15]). Similar ethnic disparities were observed at 1 year and 5 years in relation to clinical factors assessed at follow‐up. Conclusions Black survivors of stroke were ~50% less likely to be employed 1 year after stroke compared with White survivors, with Black African disadvantage persisting at 5 years after stroke. These persistent disparities were not explained by sociodemographic, stroke severity, and functional/health indicators. More research is required to better understand what drives the ethnic disparities in poststroke return to work.