Physical working conditions and subsequent sickness absence: a record linkage follow-up study among 19-39-year-old municipal employees

Comprehensive evaluation of the impact of workplace exposures on physician-certified sick leave in the general working population

BACKGROUND

Our objective was to quantify the prospective associations between work factors across chemical, physical, mechanical, and psychosocial domains and the onset of medically certified sick leave.

METHODS

Eligible respondents were interviewed in 2009, 2013, or 2016 and were registered in the national sick leave register with an employee relationship lasting more than 50 working days during the year of the survey interviews and the following year (n = 15,294 observations). To focus on the onset of high-level sick leave (HLSL; >16 days a year), we excluded individuals with HLSL during the survey year (baseline). We then used mixed-effect logistic regression models to assess prospective associations between self-reported work conditions and the occurrence of doctor-certified HLSL in the following year.

RESULTS

The average occurrence of HLSL was 13.1%. After adjusting for sex, age, level of education, chronic health problems, and smoking, we observed an exposure-response relationship between cumulative exposure to work factors within all domains and the occurrence of HLSL. When evaluating the impact of combined exposures, predicted odds ratios (OR) for employees exposed to 1, 2, and 3 or more work factors within all domains were 1.60 (95%CI 1.32 - 1.94), 2.56 (95%CI 1.73 - 3.74) and 4.09 (95%CI 2.28 - 7.25), compared to those not exposed.

CONCLUSIONS

The results support the notion that exposure to multiple work factors in various domains, including psychosocial, mechanical, chemical, and physical work conditions, is associated with an increased risk of high-level sick leave. Employers and occupational health professionals should consider the joint impact of these domains when designing interventions.

Moderating effect of cardiorespiratory fitness on sickness absence in occupational groups with different physical workloads

Sickness absence from work has a large adverse impact on both individuals and societies in Sweden and the costs for sickness absence were calculated to 64.6 billion Swedish kronor (approx. 5.6 billion in Euros) in 2020. Although high cardiorespiratory fitness may protect against potential adverse effects of high physical workload, research on the moderating effect of respiratory fitness in the relation between having an occupation with high physical workload and sickness absence is scarce. To study the moderating effect of cardiorespiratory fitness in the association between occupation and psychiatric, musculoskeletal, and cardiorespiratory diagnoses. Data was retrieved from the HPI Health Profile Institute database (1988-2020) and Included 77,366 participants (mean age 41.8 years, 52.5% women) from the Swedish workforce. The sample was chosen based on occupational groups with a generally low education level and differences in physical workload. Hurdle models were used to account for incident sickness absence and the rate of sickness absence days. There were differences in sickness absence between occupational groups for musculoskeletal and cardiorespiratory diagnoses, but not for psychiatric diagnoses. In general, the association between occupation and musculoskeletal and cardiorespiratory diagnoses was moderated by cardiorespiratory fitness in most occupational groups with higher physical workload, whereas no moderating effect was observed for psychiatric diagnoses. The study results encourage community and workplace interventions to both consider variation in physical workload and to maintain and/or improve cardiorespiratory fitness for a lower risk of sickness absence, especially in occupations with high physical workload.

Prevalence and risk factors of physical and psychological health among readymade garment workers in Bangladesh

Objective. Poor health outcomes of Bangladeshi readymade garment (RMG) workers tend to be associated with a variety of occupational factors. This study aimed to investigate the prevalence of, and risk factors associated with, the physical and psychological health outcomes of Bangladeshi RMG workers. Methods. Responses to a cross-sectional survey from a convenience sample of 411 adult Bangladeshi RMG workers (mean age = 26.24 years; SD 6.40 years; female = 80%) were analysed using bivariate and multivariate (logistic regression models) analyses. Results. More than half of the participants reported headaches (61.6%) and colds/flu (51.3%), followed by fever (37.2%), diarrhoea (32.8%), bodily pain (29.9%) and respiratory infections (20.9%). For psychological health, stress (69.1%), anxiety (66.2%) and boredom (64.5%) were most prevalent, followed by sleeplessness (51.3%), depression (48.2%) and fear (34.3%). RMG workers from the factories located in Chattogram (a peripheral region compared to Dhaka) reported poorer physical and psychological health outcomes than those working in factories in Dhaka (the capital city of Bangladesh). Overall, compared to males, female RMG workers were more likely to be vulnerable to both physical and psychological health outcomes. Conclusion. Improvement in workplace conditions and safety programmes is needed to safeguard the overall health outcomes of Bangladeshi RMG workers.

Prospective associations of psychosocial work factors with sickness absence spells and duration: Results from the French national working conditions survey

BACKGROUND

Some psychosocial work factors are associated with sickness absence, however little information is available on the associations of various psychosocial work factors and multiple exposures with sickness absence spells and duration, and gender differences.

METHODS

Data were from the French working conditions survey conducted on a nationally representative sample of the working population. The study sample included 17,437 employees (7292 men, 10,145 women) followed from 2013 to 2016 and/or from 2016 to 2019. Occupational exposures (20 psychosocial work factors, 4 working time/hours factors, 4 physical work exposures) were measured at the beginning of each follow-up period. Hurdle and multinomial models were used to study the associations with the number of days and spells of sickness absence.

RESULTS

Most of the psychosocial work factors predicted the risk of at least 1 day of sickness absence. Stronger associations were found among women than men for some factors. Psychosocial work factors were more likely to predict the number of spells than the number of days of sickness absence. Some physical work exposures predicted sickness absence spells and days, whereas shift work in women predicted the risk of at least 1 day of sickness absence. Dose-response associations were found between multiple psychosocial work exposures and sickness absence spells, and between multiple physical exposures and sickness absence spells and days.

CONCLUSION

Comprehensive prevention policies oriented toward the whole psychosocial and physical work environment should be useful to reduce sickness absence among men and women.

Within-individual changes in physical work demands associated with self-reported health and musculoskeletal symptoms: a cohort study among Dutch workers

PURPOSE

This study aimed to investigate changes in physical work demands in association with self-rated health and musculoskeletal symptoms.

METHODS

Data from five waves over the period 2019-2021 of the Netherlands Working Conditions Survey COVID-19 were available for 7191 participants aged 19-64 years who worked (partly) on-site during at least two consecutive waves. Logistic generalized estimated equations (GEE) were used to estimate the odds ratios (OR) with 95% confidence interval (CI) for changes (increase or decrease compared to no change) in physical work demands between two waves and poor self-rated health and musculoskeletal symptoms in the following wave, adjusted for the health outcome at the first wave, age, educational level, working hours and hours worked from home.

RESULTS

In females, a statistically significant association was found between an increase in physical work demands compared to no change and musculoskeletal symptoms (OR 1.39, 95% CI 1.17-1.65). A decrease in physical work demands in females was not statistically significantly associated with musculoskeletal symptoms (OR 0.93, 95% CI 0.80-1.08). Similar trends were found for poor self-rated health, although non-statistically significant. For males, comparable but attenuated associations were found.

CONCLUSION

While our study showed that increasing physical work demands are associated with adverse health (self-reported and musculoskeletal), it did not appear to benefit worker's health to reduce work demands. Future research with multiple measurements in a shorter period and additionally using devices to measure physical work demands will be needed to confirm our study results.

Labour market trajectories after part-time sickness absence: a nationwide cohort study from Finland

OBJECTIVES

The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we examined individual and work-related factors associated with following them.

DESIGN

Longitudinal register-based cohort study.

SETTING

Finnish employed population.

PARTICIPANTS

9896 receivers of partial sickness allowance aged 45-56 in the years 2010-2014.

OUTCOME

We constructed labour market trajectories based on the proportion of time spent in various labour market statuses measured over 3 years after the end of the pSA spell using multiresponse trajectory analysis. We then examined how different individual and work-related factors were associated with assignment to the different trajectory groups using logistic regression analyses.

RESULTS

The majority of the pSA users followed paths where work participation was consistently elevated (Sustained Work group, 40.4%), or only slightly reduced (Slightly Reduced Work group, 31.6%). Moreover, more than 1/10th of the users followed a path where receiving partial work disability benefits became predominant (Partial Work Disability group, 12.5%). The rest followed paths where other non-employment (Other Non-Employed group, 7.8%) or full work disability (Full Work Disability group, 7.7%) became the prevailing status. Lower educational level and income predicted assignment to all other groups than the Sustained Work group. Additional predictors were identified, yet these differed between the trajectory groups.

CONCLUSIONS

The majority of the pSA users maintained a connection to working life, yet weaker working life paths were also identified. The paths were determined by various individual and work-related factors that can help health professionals and employers to better target support measures particularly towards individuals whose connection to working life is at risk to weaken after the use of pSA.

The Joint Contributions of Overweight/Obesity and Physical and Mental Working Conditions to Short and Long Sickness Absence among Young and Midlife Finnish Employees: A Register-Linked Follow-Up Study

INTRODUCTION

Overweight/obesity and strenuous working conditions are associated with work disability, but their joint contributions to sickness absence (SA) are unknown. We aimed to examine their joint contributions to SA periods of 1-7 and ≥8 days.

METHODS

Self-reported data on body mass index and working conditions, including perceived physically and mentally strenuous work and hours per day spent in heavy physical work, were linked to the employer's SA register for the City of Helsinki, Finland, employees (n = 4,323, women 78%) who were 19-39 years old at baseline. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for SA periods using negative binomial regression models among participants with healthy weight and overweight/obesity, with and without exposure to strenuous working conditions. The mean follow-up time was 2.1 years.

RESULTS

Participants with overweight/obesity and exposure to physically strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of both 1-7 and ≥8 days (physically strenuous work: RR: 1.38, CI: 1.25-1.52, and RR: 1.87, CI: 1.60-2.18, respectively; ≥3 h per day spent in physical work: RR: 1.40, CI: 1.26-1.55 and 2.04, CI: 1.73-2.40, respectively). The interaction between overweight/obesity and physically strenuous working conditions was additive for SA periods of 1-7 days and weakly synergistic for SA periods of ≥8 days. For mentally strenuous work, participants with overweight/obesity and exposure to mentally strenuous work had the highest age-adjusted RRs for SA periods of ≥8 days, and the interaction was additive.

CONCLUSION

The joint contributions of overweight/obesity and exposure to strenuous working conditions to SA should be considered when aiming to reduce employees' SA. Employers might benefit from providing employees adequate support for weight management and adherence to healthy lifestyles while improving employees' working conditions.

Sickness absence around contact with outpatient mental health care services - differences between migrants and non-migrants: a Norwegian register study

BACKGROUND

Mental disorders are a leading cause of sickness absence. Some groups of migrants are at higher risk of both mental disorder and sickness absence. Yet, research on sickness absence in relation to mental disorders among migrants is limited. This study investigates differences in sickness absence in the twelve-month period around contact with outpatient mental health services between non-migrants and various migrant groups with different length of stays. It also considers whether these differences are similar for men and women.

METHODS

Using linked Norwegian register data, we followed 146,785 individuals, aged 18-66 years, who had attended outpatient mental health services and who had, or had recently had, a stable workforce attachment. The number of days of sickness absence was calculated for the 12-month period surrounding contact with outpatient mental health services. We applied logistic regression and zero-truncated negative binomial regression to assess differences in any sickness absence and number of days of absence between non-migrants and migrants, including refugees and non-refugees. We included interaction terms between migrant category and sex.

RESULTS

Refugee men and other migrant men from countries outside the European Economic Area (EEA) had a higher probability of any sickness absence in the period surrounding contact with outpatient mental health services than their non-migrant counterparts. Women from EEA countries with stays of less than 15 years had a lower probability than non-migrant women. Additionally, refugees, both men and women, with 6-14 years in Norway had more days of absence while EEA migrants had fewer days than their non-migrant counterparts.

CONCLUSIONS

Refugee men and other non-EEA migrant men appear to have higher sickness absence than non-migrant men around the time of contact with services. This finding does not apply to women. Several probable reasons for this are discussed, though further research is required to understand why. Targeted strategies to reduce sickness absence and support the return to work for refugees and other non-EEA migrant men are needed. Barriers to timely help-seeking should also be addressed.

Occupational injuries and risk assessment among stone crushing industry workers: a cross-sectional study

BACKGROUND AND OBJECTIVES

The prevalence of occupational injuries among blue-collar workers is higher in the stone-crushing industries due to high-risk and iterant nature of the work. These occupational injuries, in turn, caused workers' ill health, as well as death, which eventually diminish the gross domestic product. We aimed at assessing the attributes of occupational injuries and the risk associated with the hazards in the stone-crushing industry.

METHODS

This study utilized a questionnaire base cross-sectional survey that was conducted from September 2019 to February 2020. Data were collected from 32 stone-crushing factories of Eastern Bangladesh and analyzed to show their relationship with different variables. The risk levels associated with the frequent hazardous events were measured using a Semi-Quantitative Risk Assessment Matrix.

RESULTS

Most of the injuries were found to occur between 12:00 and 16:00 h. Nearly a fifth of the injuries were serious or critical in nature, caused the workers to be absent at least a week. Exposure to excessive dust, working without personal protective equipment (PPE), and improper lifting and handling techniques caused one-third of injuries. Wrist and hand/fingers, back and lower back, feet/toe, eye, knee, arm, neck and head, and ankle were found as most injured body parts. The primary cause of most injuries was the workers' failure to use PPE. All major hazardous events were found to possess a high-risk level.

CONCLUSION

Our finding suggests that stone crushing is one of the most hazardous industries and the practitioners must consider the findings when implementing a risk avoidance policy.

Latent classes of unhealthy behaviours and their associations with subsequent sickness absence: a prospective register-linkage study among Finnish young and early midlife employees

OBJECTIVES

Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have considered person-oriented approach in these associations. Using latent class analysis, we examined clustering of unhealthy behaviours among Finnish municipal employees and their associations with subsequent SA.

DESIGN

A prospective register-linkage study.

SETTING

Unhealthy behaviours (low leisure-time physical activity, non-daily fruit and vegetable consumption, insufficient sleep, excessive alcohol use and tobacco use) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19- to 39-year-old employees of the City of Helsinki, Finland.

PARTICIPANTS

A total of 4002 employees (81% women) of the City of Helsinki, Finland.

PRIMARY OUTCOME MEASURES

The questionnaire data were prospectively linked to employer's SA register through March 2020. Associations between latent classes of unhealthy behaviours and subsequent SA (1-7 days/8+ days/all lengths) were examined using negative binomial regression.

RESULTS

Among women, a three-class latent class model was selected: (1) few unhealthy behaviours (84%), (2) excessive alcohol and tobacco use (12%) and (3) several unhealthy behaviours (5%). Women belonging to classes 2 and 3 had increased SA rates compared with those in class 1, regardless of the length of SA spells. Among men, a 2-latent class model was selected: (1) few unhealthy behaviours (53%) and (2) several unhealthy behaviours (47%). Men belonging to class 2 had increased rates of 1-7 days' SA compared with men in class 1.

CONCLUSIONS

This study suggests that preventive actions aiming to reduce employees' SA should consider simultaneously several unhealthy behaviours. Targeted interventions may benefit of identifying the clustering of these behaviours among occupational groups.