The role of the workplace in the production and containment of health costs: the case of stress-related disorders

The annual costs of cardiovascular diseases and mental disorders attributable to job strain in France

BACKGROUND

Work stress has become a major occupational risk factor in industrialized countries and an important economic issue. The objective was to estimate the annual costs of coronary heart diseases (CHD) and mental disorders (MD) attributable to job strain exposure according to Karasek's model in France for the year 2003 from a societal perspective.

METHODS

We produced attributable fraction estimates which were applied to the number of cases (morbidity and mortality) and the costs of CHD and MD. Relative risk estimates came from a systematic literature review of prospective studies. We conducted meta-analyses based on this selection of studies. Prevalence of exposure to job strain came from the national SUMER survey conducted in France in 2003. Costs included direct medical costs and indirect costs: production losses due to sick leaves and premature deaths.

RESULTS

Between 8.8 and 10.2% of CHD morbidity was attributable to job strain, and between 9.4 and 11.2% of CHD mortality was attributable to this exposure for men. Between 15.2 and 19.8% of MD was attributable to job strain for men, and between 14.3 and 27.1% for women. As a whole, between 450 000 and 590 000 cases of diseases and 910-1130 deaths were attributable to job strain for men. From 730 000 to 1 380 000 cases of diseases and from 150 to 280 deaths were attributable to job strain for women. The total number of sick leave days amounted from 5 to 6.6 million days for men, and from 8.5 to 16 million days for women. The total costs of CHD and MD attributable to job strain exposure ranged from 1.8 to 3 billion euros for the year 2003 (0.12-0.19% GDP). Medical costs accounted for 11% of the total costs, value of life costs accounted for 13-15% and sick leave costs for 74-77%. The cost of CHD was estimated at 113-133 million euros and the cost of MD was between 1.7 - 2.8 billion euros in 2003.

CONCLUSION

This study on the economic burden of diseases attributable to job strain in France provides relevant insights for policy-makers when defining public health priorities for prevention policies.

Determinants of regional differences in sick leave duration for homogeneous groups in The Netherlands: their implications for social security policy-making

OBJECTIVES

Regional differences in sick leave duration determinants were studied between in age and profession homogeneous groups in different regions in The Netherlands, i.e. Utrecht and Southern Limburg, in order to find any effects of socio-cultural factors.

MATERIAL AND METHODS

137 participants in Utrecht and Southern Limburg were interviewed. Data of sick leave duration were obtained from the social fund.

RESULTS

A statistical comparison of sick leave duration figures showed that, in Southern Limburg, determinants of 'health status' (questions about perceived health and burnout due to work) and 'individual characteristics and circumstances' (age, gender and satisfaction with private circumstances) were associated with sick leave duration and, in Utrecht, the 'work contents' determinant autonomy.

CONCLUSIONS

In the regions studied, different determinants appeared to be associated with sick leave duration and for some of them the European integration was assumed to have a lasting effect. Nationwide policy interventions to reduce sick leave duration should take into account the existence of regional differences in determinants predicting sick leave duration and the potential effects of different socio-cultural characteristics on laying claim to social security.

Genotypic interaction between DRD4 and DAT1 loci is a high risk factor for attention-deficit/hyperactivity disorder in Chilean families

Attention-deficit/hyperactivity disorder, ADHD [MIM 126452], is a common, highly heritable neurobiological disorder of childhood onset, characterized by hyperactivity, impulsiveness, and/or inattentiveness. As part of an ongoing study of ADHD, we carried out a family-based discordant sib-pair analysis to detect possible associations between dopamine receptor D4 (DRD4) and dopamine transporter 1 (DAT1) polymorphisms and ADHD in Chilean families. Both loci individually classified as homozygotes or heterozygotes for the DRD4 7-repeat and DAT1 10-repeat alleles, did not exhibit genotype frequency differences between affected children and their healthy siblings (Fisher's exact test P > 0.25 in both cases). However, the simultaneous presence of both DRD4 7-repeat heterozygosity and DAT1 10 allele homozygosity were significantly higher (34.6%) in cases (26), compared with their unaffected siblings (25) (4%; Fisher's exact test P = 0.0096; odds-ratio, OR = 12.71). Increased density of dopamine transporter in ADHD brains, along with abundance of 7-repeat D4 receptors in prefrontal cortex, which is impaired in ADHD patients, make the observed gene-gene interaction worthy of further incisive studies.