Welfare state and disability. The relationship between stroke and disability depends on the health care system

Alexander Barth, University of Rostock
Gabriele Doblhammer-Reiter, University of Rostock
Dorly J. H. Deeg, Vrije Universiteit Amsterdam

Europe will be faced with an aging population, and thus with a growing incidence of stroke, which often causes serious physical limitations. Reducing the impact of stroke on limitations in daily activities is important when dealing with the challenges associated with future demographic shifts, as it would help to minimize the increase in the number of older people with these disabilities. This is the first study to investigate country-level differences in Europe in the effect of stroke on disability in activities of daily living using multilevel random effects logistic regression models with data from the fourth wave of SHARE. The pattern of the disabling impact of stroke is mostly clustered regionally. The western and southern European countries form distinct groups. Western European countries perform better than southern European countries. Sweden shows the best results, but Denmark's performance is more similar to that of the southern countries than to the western European countries or Sweden. In Italy, stroke is associated with nearly four times the disability risk as in Sweden; and in Spain, the disability risk is three times as high as in Sweden. Even in countries like Germany or the Netherlands and the remaining western European region, stroke is associated with more than double the risk found in Sweden. Other causes of disability besides stroke, e.g. other chronic diseases or socio-economic status show far less variation on the country-level. Future research should concentrate on investigating the causal pathways in relation to the specific properties of health care systems, thereby identifying opportunities for targeted reform. This may help to decrease the inequalities found in the disabling effects of stroke, especially in the southern countries. To address the causes of disability in addition to stroke, efforts of policy makers could be rooted in preventing the further spread of socioeconomic inequity and inequality.