Socioeconomic and sex differentials in reason for sickness absence from the Whitehall II Study

OBJECTIVES

Large socioeconomic differences exist in disease and mortality. This paper describes the distribution of specific medical reasons for sickness absence by grade of employment in the Whitehall II study and validates the medical reason by comparison with general practitioners' records.

METHODS

Analysis of sickness absence data on 5620 male and female civil servants aged 35-55 years. Data have been collected from 12 of the 20 London based civil service departments participating in the Whitehall II study, where medical reason for absence was available. Rates and distributions of reasons for absence for short spells (< or = 7 days) and long spells (> 7 days) were analysed.

RESULTS

Respiratory disorders and gastroenteritis accounted for over half of all spells of absence, with headache and migraine, musculoskeletal disorders, injury, and neurosis accounting for a further 20%-30% of absences. There was an inverse association with employment grade, the lower the grade the higher the rate of absence for both short spells (< or = 7 days) and long spells (> 7 days). In general, women had higher rates of absence than men. Comparison of reason for very long spells of absence (> 21 days) showed moderate agreement between civil service and general practitioner.

CONCLUSION

There is a lack of national comprehensive data on sickness absence and medical reason for absence, in particular for women and for spells of different duration. Data from the Whitehall II study show large employment grade and sex differences in the distribution of medical reasons for absence that are similar to socioeconomic differences in morbidity documented in other studies. Possible explanations include the subjective nature of illness and disease; the work/family interface; and the influence of the absence culture. Longer term follow up will provide information on whether sickness absence relates to serious morbidity and mortality.

Sickness absenteeism among employees of a teaching hospital in Saudi Arabia

The sickness absence records of workers at the King Khalid University Hospital over a period of two years (1990-1991) were analysed to identify the category of workers at high risks. The records of each staff who went on 'sick-off' are available at the Employee Health Clinic of the hospital. There were 861 workers with sickness absence records during the period of study and 86% are expatriates on contract. The prevalence of sickness absence is higher among contract workers than non-contract workers about 16% and 9% respectively. The sex ratio was 1:2 in favour of females among contract employees but 1.2:1 in the male's favour for the Saudis. The observed sex differential in the rate of sickness absence in each occupational group is statistically significant (P < 0.01). Females have more spells of sickness than males and the duration of sickness absence is significantly higher in females. However, the average spell of sickness which is generally low is not different between contract and non-contract workers although slightly higher in the former. There was no significant occupational effect on the spells and duration of sickness absence. Respiratory infections and diseases of the digestive and musculoskeletal systems are the major diseases causing sickness absence. The implications of these findings are discussed in the paper. But for a good monitoring of sickness absence records, a health record surveillance card for each employee is recommended.

Absenteeism among survivors of the atomic bombing of Hiroshima

Atomic bomb survivors who worked at the Atomic Bomb Casualty Commission in Hiroshima during the years 1968-71 and held handbooks identifying them as survivors took significantly more days of both annual leave and sick leave than did matched and paired control subjects. These differences in leave-taking patterns are considered to be due to behavioural causes as they could not be attributed to radiation dose-response effects.

An anatomy of occupational medicine

Lee, W. R. (1973).British Journal of Industrial Medicine,30, 111-117. An anatomy of occupational medicine. Previous writers have attempted to describe occupational medicine by considering the functions of a doctor working in industry. In different communities, and even in the same community at different times, a doctor working in industry may have different functions. `Occupational medicine', so described, would therefore not be a discipline but would merely be medicine practised in a certain area. Furthermore, such an approach leaves out other aspects of occupational medicine such as recompense for injury at work and statutory supervision of workplaces, and any interaction between these two.

Men think in terms of conceptual models which predetermine to a greater or less extent their approach to future problems. The present essay attempts to formulate a coherent intellectual framework of occupational medicine.

The conceptual model proposed here is based on the globe proposed by Himsworth (1970) as a model representing the structure of scientific knowledge. Using this, a place for occupational medicine can be determined related to medicine, industry, and the `basic' sciences. Occupational medicine is thus seen as a coherent entity.

The argument is supported by a comparison of some of the provisions for occupational medicine in this country and in France. In this comparison the underlying components are distinguished from the mechanisms set up to deal with them. It is these components which go to make up the structure of occupational medicine and it is the coherence and close relationship of them which must be studied to find and describe an entity to be called occupational medicine.