
By Jill Pease

People who have language impairments after stroke, also known as aphasia, experience significant impact on income and wealth, finds a new study by researchers at the University of Florida College of Public Health and Health Professions. Their findings appear in the journal Frontiers in Stroke.

Compared to stroke survivors who do not have language problems, those with aphasia had 21% lower income and 7% lower wealth. The disparities were even greater among Black patients with aphasia. They experienced 29% lower income and 24% lower wealth.
Aphasia, which causes problems speaking, reading, writing and understanding words, occurs in about a third of people who have a stroke. While scientists have a good understanding of aphasia as a communication disorder, not much is known about how it impacts other areas of a patient’s life, including financial effects, said investigator Charles Ellis Jr., Ph.D., a professor and chair of the PHHP Department of Speech, Language, and Hearing Sciences.
Ellis, who studies neurologically based communication disorders, and Molly Jacobs, Ph.D., an associate professor and health economist in the PHHP Department of Health Services Research, Management and Policy, partnered to explore the financial strain, also described as “financial toxicity,” associated with aphasia. Financial stresses, compounded with recovering from the effects of stroke, can negatively affect patient’s physical and mental health, Ellis said.
“The ramifications are intersectional and mutually deterministic,” he said. “Patients can easily experience multiple, successive, interrelated setbacks in their physical recovery, communication recovery, well-being and mental health that are not easy to untangle. People who have strokes and aphasia are at high risk for additional strokes so this is not a one-time issue.”
For the study, the investigators analyzed data from the Medical Expenditure Panel Study, a nationally representative dataset with factors such as health status and health care use, socioeconomic characteristics, employment, health care expenditures and insurance coverage for U.S. adults. To analyze financial impacts, the authors considered two factors: income, which refers to an individual’s annual earnings, and wealth, a calculation of assets, minus debt.
Financial toxicity is described as the “toxic” effects a health condition can have on a person’s finances. It is estimated that 56% of U.S. adults experience financial toxicity, many of whom have health insurance. A 2023 study by Jacobs and Ellis estimated the annual cost of having aphasia to be more than $30,000, due to medical expenses, lost wages and informal caregiving.
Compared to other stroke survivors, those with aphasia may experience more difficulties returning to work following a stroke, which may contribute to their lower income.
“Many folks with stroke and physical disability can return to work with accommodations,” Ellis said. “There are few accommodations for effective and efficient communication in the workplace for people with aphasia.”
A first step in addressing aphasia-related health and financial disparities may be increasing clinician awareness of not only the cost of treatment, but also the variation in patient experience, Ellis said.
“Most people view all strokes the same and believe the impact is the same across sociodemographic characteristics,” he said.
In addition, targeted interventions are needed to address the health care and financial needs of people with aphasia, particularly Black patients, the authors argue. These may include rehabilitation and job re-entry programs tailored to people with communication disabilities.
“Such efforts will help ensure that all individuals, regardless of their communication abilities or racial background, have equitable opportunities for financial recovery and stability.”