A literature review on sick leave determinants (1984-2004)

Identifying pain profiles in employees including work-related factors and pain perceptions: a cross-sectional study in Belgian companies

OBJECTIVES

Studies usually investigate a limited number or a predefined combinations of risk factors for sickness absence in employees with pain. We examined frequently occurring combinations across a wide range of work-related factors and pain perceptions.

DESIGN

Cross-sectional study.

SETTING

Belgian companies that are under supervision of IDEWE, an external service for prevention and protection at work.

PARTICIPANTS

In total, 249 employees experiencing pain for at least 6 weeks were included and filled out an online survey.

OUTCOMES

Latent profile analysis was used to differentiate profiles of work-related factors (physical demands, workload, social support and autonomy) and pain perceptions (catastrophising, fear-avoidance beliefs and pain acceptance). Subsequently, profiles were compared on sociodemographics (age, gender, level of education, work arrangement, duration of complaints, multisite pain and sickness absence in the previous year) and predictors of sickness absence (behavioural intention and perceived behavioural control).

RESULTS

Four profiles were identified. Profile 1 (38.2%) had favourable scores and profile 4 (14.9%) unfavourable scores across all indicators. Profile 2 (33.3%) had relatively high physical demands, moderate autonomy levels and favourable scores on the other indicators. Profile 3 (13.7%) showed relatively low physical demands, moderate autonomy levels, but unfavourable scores on the other indicators. Predictors of profiles were age (OR 0.93 and 95% CI (0.89 to 0.98)), level of education (OR 0.28 and 95% CI (0.1 to 0.79)) and duration of sickness absence in the previous year (OR 2.29 and 95% CI (0.89 to 5.88)). Significant differences were observed in behavioural intention (χ2=8.92, p=0.030) and perceived behavioural control (χ2=12.37, p=0.006) across the four profiles.

CONCLUSION

This study highlights the significance of considering the interplay between work-related factors and pain perceptions in employees. Unfavourable scores on a single work factor might not translate into maladaptive pain perceptions or subsequent sickness absence, if mitigating factors are in place. Special attention must be devoted to employees dealing with unfavourable working conditions along with maladaptive pain perceptions. In this context, social support emerges as an important factor influencing sickness absence.

Sequence analysis of sickness absence and disability pension days in 2012-2018 among privately employed white-collar workers in Sweden: a prospective cohort study

OBJECTIVE

The aim of the study is to explore sequences of sickness absence (SA) and disability pension (DP) days from 2012 to 2018 among privately employed white-collar workers.

DESIGN

A 7-year prospective cohort study using microdata from nationwide registers.

SETTING

Sweden.

PARTICIPANTS

All 1 283 516 privately employed white-collar workers in Sweden in 2012 aged 18-67.

METHODS

Sequence analysis was used to describe clusters of individuals who followed similar development of SA and DP net days/year, and multinomial logistic regression to analyse associations between sociodemographic variables and belonging to each observed cluster of sequences. Odds ratios (ORs) and 95% confidence intervals (CIs) were adjusted for baseline sociodemographics.

RESULTS

We identified five clusters of SA and DP sequences: (1) 'low or no SA or DP' (88.7% of the population), (2) 'SA due to other than mental diagnosis' (5.2%), (3) 'SA due to mental diagnosis' (3.4%), (4) 'not eligible for SA or DP' (1.4%) and (5) 'DP' (1.2%). Men, highly educated, born outside Sweden and high-income earners were more likely to belong to the first and the fourth cluster (ORs 1.13-4.49). The second, third and fifth clusters consisted mainly of women, low educated and low-income (ORs 1.22-8.90). There were only small differences between branches of industry in adjusted analyses, and many were not significant.

CONCLUSION

In general, only a few privately employed white-collar workers had SA and even fewer had DP during the 7-year follow-up. The risk of belonging to a cluster characterised by SA or DP varied by sex, levels of education and income, and other sociodemographic factors.

Trends in Associations Between Sickness Absence Before the Age of 65 and Being in Paid Work After the Age of 65: Prospective Study of Three Total Population Cohorts

The increasing workforce participation at higher ages may impact social insurance systems, however, this has hardly been studied at all. We studied associations between sociodemographic factors and prior sickness absence and disability pension, with having paid work and sickness absence after age 65, and if such associations changed over time. We used longitudinal register data regarding three cohorts of all residents in Sweden who turned 65 in 2000, 2005, or 2010 (N = 50,000, 68,000, and 99,000, respectively). Although employment rates when aged 66-71 increased between the cohorts, associations of sociodemographic factors with paid work and sickness absence, when aged 66-71 did not. Both sickness absence and disability pension when aged 60-64 were negatively associated with working past 65. Sickness absence when aged 60-64 was positively associated and disability pension was negatively associated with sickness absence after 65. Possibilities to remain in paid work with different health conditions need to be strengthened to avoid inequalities when raising the retirement age.

Use of Health Services and Rehabilitation before and after the Beginning of Long-Term Sickness Absence-Comparing the Use by Employment and Disability Pension Transition after the Sickness Absence in Finland

The objective of the study was to follow the health care and rehabilitation use before, during and after long-term sickness absence (LTSA), and to compare the use by post-LTSA labour market situation in terms of disability pension and employment. Individuals aged 18-58 with a ≥30-day LTSA spell in 2015 (N = 2427) were included from the total population of the city of Oulu, Finland. Register data included LTSA spells, outpatient health care visits, inpatient care spells and rehabilitation spells, disability pensions (DP), employment dates, and demographic, socioeconomic and disability-related covariates. The study population was followed for one year before, and three years after the start of LTSA. Negative binomial regression models were utilized to examine covariate-adjusted use of the three service types and group differences. The use of outpatient health care peaked at the start of the LTSA spell, and adjusted for covariates, the height of the peak was similar regardless of post-LTSA labour market situation. Adjusted for covariates, those who transferred to permanent DP after an LTSA used more outpatient (predicted mean 4.87 for attendance days quarterly, 95% CI 4.36-5.38) and inpatient (predicted mean 84 days quarterly, 95% CI 0.62-1.06) health care than others during three years after the start of LTSA. Individuals not employed after an LTSA showed the highest and increasing level of rehabilitation use. The results indicate that Individuals returning to employment after an LTSA are provided with relatively high amount of early outpatient care, possibly aiding the return. For individuals not employed after an LTSA, rehabilitation is used quite frequently but rather late in the disability process. The frequent use of health care among future disability pensioners is consistent with their increasing health problems leading to retirement.

Risks of COVID-19 by occupation in NHS workers in England

OBJECTIVE

To quantify occupational risks of COVID-19 among healthcare staff during the first wave (9 March 2020-31 July 2020) of the pandemic in England.

METHODS

We used pseudonymised data on 902 813 individuals employed by 191 National Health Service trusts to explore demographic and occupational risk factors for sickness absence ascribed to COVID-19 (n=92 880). We estimated ORs by multivariable logistic regression.

RESULTS

With adjustment for employing trust, demographic characteristics and previous frequency of sickness absence, risk relative to administrative/clerical occupations was highest in 'additional clinical services' (care assistants and other occupations directly supporting those in clinical roles) (OR 2.31 (2.25 to 2.37)), registered nursing and midwifery professionals (OR 2.28 (2.23 to 2.34)) and allied health professionals (OR 1.94 (1.88 to 2.01)) and intermediate in doctors and dentists (OR 1.55 (1.50 to 1.61)). Differences in risk were higher after the employing trust had started to care for documented patients with COVID-19, and were reduced, but not eliminated, following additional adjustment for exposure to infected patients or materials, assessed by a job-exposure matrix. For prolonged COVID-19 sickness absence (episodes lasting >14 days), the variation in risk by staff group was somewhat greater.

CONCLUSIONS

After allowance for possible bias and confounding by non-occupational exposures, we estimated that relative risks for COVID-19 among most patient-facing occupations were between 1.5 and 2.5. The highest risks were in those working in additional clinical services, nursing and midwifery and in allied health professions. Better protective measures for these staff groups should be a priority. COVID-19 may meet criteria for compensation as an occupational disease in some healthcare occupations.

TRIAL REGISTRATION NUMBER

ISRCTN36352994.

Outpatient healthcare use before and during a long-term sickness absence spell: a register-based follow-up study comparing healthcare use by the length of sickness absence and transition to disability pension in Finland

OBJECTIVES

The objective of the study was to examine outpatient healthcare use before and during a long-term sickness absence (LTSA), and to compare the development of healthcare use between groups defined through LTSA lengths and disability pension (DP) transition.

DESIGN

Register-based longitudinal study with five 6-month periods before and after the start of the LTSA spell in early 2016.LTSA groups 1 (N=210) and 2 (N=187) went on to reach the statutory maximum LTSA length, with group 1 transitioning to DP. Group 3 (N=3082) had a shorter LTSA spell. Control group 4 (N=92 921) had no LTSA.

SETTING AND PARTICIPANTS

Non-retired individuals aged 20-59, with no LTSA during 2015 (N=96 400) were included from the total population of the city of Oulu, Finland. Register data were linked on LTSA spells and outpatient healthcare use 2013-2018, DP status in 2018, and various covariates.

MAIN OUTCOME MEASURES

Negative binomial regression models were used to examine the covariate-adjusted number of healthcare visits, and to examine the association of the LTSA groups with healthcare use before and after the start of LTSA (incidence rate ratios and predicted means).

RESULTS

Individuals eventually reaching the maximum LTSA length (groups 1 and 2) had a higher level of healthcare use before the LTSA and especially after the start of LTSA than others. Individuals transferring to DP after the maximum LTSA (group 1) used healthcare the most after the start of LTSA.

CONCLUSIONS

The risk for at least 1 year's disability may be identified by frequent outpatient healthcare use years before LTSA. However, future disability retirees could not be identified through their pre-LTSA healthcare use. Instead, their high use of healthcare after the start of the LTSA was consistent with their increasing health problems leading to retirement.

The Prospective Association Between Physical Activity, Insomnia Symptoms and Productivity in an Australian Population-based Cohort

OBJECTIVES

To investigate the joint, prospective associations of physical inactivity and insomnia symptoms and productivity using the 2013 and 2014 Household Income and Labor Dynamics in Australia Survey panel data.

METHODS

The association between i) presenteeism (yes/no, n=5864) and ii) absenteeism (sick leave days, n = 4324) and the mutually exclusive groups "active without insomnia", "active with insomnia", "inactive without insomnia" and "inactive with insomnia" was assessed.

RESULTS

Participants "active with insomnia" or "inactive with insomnia" had greater odds of presenteeism than those "active without insomnia" (OR = 1.41, 95%CI: 1.07-1.85 and OR=1.44, 95%CI: 1.14-1.83 respectively). Participants "inactive with insomnia" had a greater incidence of absenteeism than participants "active without insomnia" (IRR=1.28, 95%CI: 1.07-1.54).

CONCLUSIONS

Findings suggest improving physical activity levels and insomnia symptoms concurrently may improve productivity by reducing presenteeism and sick leave.

Efficacy of an indicated prevention strategy on sickness absence and termination of the employment contract: a 5-year follow-up study

Objective:

It was shown that an indicated prevention strategy (IPS), based on screening and early intervention, can considerably decrease future risk of long-term sickness absence (LTSA>28 days) over one year. Given the nature of the interventions, the potential of an effect extending beyond the original one year of follow-up might be present. This study aims to determine the efficacy of this IPS on LTSA and termination of employment contract over five years by extended follow up of IPS trials.

Methods:

Company records on sickness absence and termination of employment contract over five years were used from two randomized controlled trials (RCT) on the efficacy of the IPS (RCT I employees at high-risk for LTSA: intervention: N=263; RCT II high-risk employees with concurrent mild depressive complaints: intervention: N=139). Survival analysis was used to model time until the first LTSA episode and termination of employment contract.

Results:

RCT I showed a decrease of 43.2 days of sickness absence (P=0.05) and a lower 5-year risk of LTSA in the intervention, as compared to the control group [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.41–0.90], however no considerable impact on employment contract (HR 0.85, 95% CI 0.54–1.35) (intention-to-treat, ITT). For RCT II, we found no large difference in days of SA and no difference in LTSA risk over five years (HR 1.31, 95% CI 0.70–2.47), whereas the risk of termination of the employment contract was lower (HR 0.62, 95% CI 0.39–0.99) (ITT).

Conclusion:

Effects of the IPS were observed over five years, albeit differential between the two approaches. A combination of elements of both interventions might lead to optimal results but needs further study.

Sickness Absence and Sickness Presence Among Health and Care Employees in Sweden-Health Complaints, Health Behavior, and Future Long-Term Sickness Absence

OBJECTIVE

To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA).

METHODS

Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted.

RESULTS

Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses' high SP and care assistants' high SA elevated the LTSA risk.

CONCLUSIONS

Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.

Personality traits, working conditions and health: an empirical analysis based on the German Linked Personnel Panel, 2013–2017

We conduct a comprehensive analysis of health determinants at the individual and workplace levels. Using a new individual-level German data set, we investigate the influence of these determinants on health, including collegiality, personality traits as measured by the Big Five, commitment to the company and job characteristics, while controlling for a set of standard sociodemographic and employment variables. We are interested in which determinants are important and which are less influential, whether interaction effects should be taken into account and whether the results depend on the modeling and estimation method used. Among the Big Five factors, conscientiousness, agreeableness and emotional stability are positively correlated with good overall health. The influence of job characteristics such as having substantial decision-making authority, not having physically demanding tasks, having pleasant environmental conditions, facing minimal time pressure and not being required to multitask are also positive. If employees frequently receive help when needed from their colleagues and do not feel unfairly criticized by others in the firm, they usually have fewer health problems. Each Big Five item influences mental health, whereas no statistical significance could be found for these items’ relationships with the number of days workers were absent due to sickness, except for neuroticism. These results are, for the most part, robust to different modeling and estimation methods.

Public managers' role in creating workplace social capital (WSC) and its effect on employees' well-being and health: a protocol of a longitudinal cohort study (PUMA-WSC)

INTRODUCTION

Workplace social capital (WSC) has been shown to affect employees' well-being and health, yet it is not clear how public managers can create WSC and which forms of WSC are most important. This study is the first prospective cohort study to examine the relationship between management behaviour, WSC, well-being and sickness absence. It uses a validated and detailed scale on WSC, which can distinguish between bonding, bridging, linking and organisational WSC over time. The study thereby provides rich data giving a much-needed detailed image of how WSC impacts on public employees' well-being and health. Additionally, the study pays special attention to the fact that these relationships can be different for different types of employees and therefore tests a set of relevant employee and context-related variables.

METHODS AND ANALYSIS

Project preparations in terms of agreements and data preparation of existing data started in 2019. This prospective cohort study considers and collects organisational data from 2016 to 2025. Annual employee surveys of more than 8000 employees (in a large Danish municipality) will be combined with register data in all years. This generates a unique cohort of public employees in different professions that are traceable over several years. The annual surveys include information on the management behaviour, WSC and employee outcomes. Fine-grained information on sickness absences will be matched for all employees and years under study. Moreover, confounders and the nested nature of the data will be considered.

ETHICS AND DISSEMINATION

Approval has been obtained from The Regional Committee on Health Research Ethics from Southern Denmark and from the University of Southern Denmark. The results will be presented at conferences and published in international peer-reviewed journals and in a practice-oriented monography targeted at public managers. The result will furthermore be disseminated to the involved employees through seminars and workshops in the participating organisations.

Modeling sickness absence data: A scoping review

The identification of sick leave determinants could positively influence decision making to improve worker quality of life and to reduce consequently costs for society. Sick leave is a research topic of interest in economics, psychology, health and social behaviour. The question of choosing an appropriate statistical tool to analyse sick leave data can be challenging. In fact, sick leave data have a complex structure, characterized by two dimensions: frequency and duration, and involve numerous features related to individual and environmental factors. We conducted a scoping review to characterize statistical approaches to analyse individual sick leave data in order to synthesise key insights from the extensive literature, as well as to identify gaps in research. We followed the PRISMA methodology for scoping reviews and searched Medline, World of Science, Science Direct, Psycinfo and EconLit for publications using statistical modeling for explaining or predicting sick leave at the individual level. We selected 469 articles from the 5983 retrieved, dated from 1981 to 2019. In total, three types of model were identified: univariate outcome modeling using for the most part count models (438 articles), bivariate outcome modeling (14 articles), such as multistate models and structural equation modeling (22 articles). The review shows that there was a lack of evaluation of the models as predictive accuracy was only evaluated in 18 articles and the explanatory accuracy in 43 articles. Further research based on joint models could bring more insights on sick leave spells, considering both their frequency and duration.

Sickness absence and disability pension in relation to first childbirth and in nulliparous women according to occupational groups: a cohort study of 492,504 women in Sweden

Background

Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and those without occupation.

Methods

We studied nulliparous women aged 18–39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within 3 years (B0), first childbirth in 2005 with no childbirth within 3 years (B1), and first childbirth in 2005 with at least one more birth within 3 years (B1+). We compared crude and standardized annual mean SA (in spells> 14 days) and DP net days in the 3 years before and 3 years after first childbirth date.

Results

Women in the highest skill level occupations and managers, had less mean SA/DP days during most study years than women in the lowest skill level occupations group. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year.

Conclusions

We found that women’s mean SA/DP days before and after first childbirth was higher with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.

Socio-demographic contributors to health and safety of mine workers in South Africa

BACKGROUND

Mine workers in South Africa face various health and safety risks, and socioeconomic challenges.

OBJECTIVE

This study aimed to assess the associations between socio-demographic factors and health, safety and wellness in the South African mining industry.

METHODS

Qualitative and quantitative data were collected from 64 interviews with mine management and labour representatives, 14 focus groups with mine workers, and 875 questionnaires completed by mine workers from three platinum, two gold, one coal, one diamond, and one manganese mine in South Africa.

RESULTS

Health challenges included non-communicable diseases, HIV/AIDS, tuberculosis (TB), and respiratory diseases, while safety challenges included worker behaviour, stress and fatigue. Socio-demographic factors associated with disease, sick leave, fatigue, accidents and job satisfaction included age, length of service, race, nationality, education, mining sector, work status, income, housing, domestic crowding, sleep, exercise, alcohol use, and perceived quality of life.

CONCLUSION

Socio-demographic factors should be taken into consideration when developing workplace health and safety programmes.

Cardiorespiratory Fitness and Device-Measured Sedentary Behaviour are Associated with Sickness Absence in Office Workers

Physical activity reduces the risk of several noncommunicable diseases, and a number of studies have found self-reported physical activity to be associated with sickness absence. The aim of this study was to examine if cardiorespiratory fitness, device-measured physical activity, and sedentary behaviour were associated with sickness absence among office workers. Participants were recruited from two Swedish companies. Data on sickness absence (frequency and duration) and covariates were collected via questionnaires. Physical activity pattern was assessed using ActiGraph and activPAL, and fitness was estimated from submaximal cycle ergometry. The sample consisted of 159 office workers (67% women, aged 43 ± 8 years). Higher cardiorespiratory fitness was significantly associated with a lower odds ratio (OR) for both sickness absence duration (OR = 0.92, 95% confidence interval (CI) 0.87-0.96) and frequency (OR = 0.93, 95% CI 0.90-0.97). Sedentary time was positively associated with higher odds of sickness absence frequency (OR = 1.03, 95% CI 0.99-1.08). No associations were found for physical activity at any intensity level and sickness absence. Higher sickness absence was found among office workers with low cardiorespiratory fitness and more daily time spent sedentary. In contrast to reports using self-reported physical activity, device-measured physical activity was not associated with sickness absence.

The Combined Effect of Poor Perceived Indoor Environmental Quality and Psychosocial Stressors on Long-Term Sickness Absence in the Workplace: A Follow-Up Study

Background: Poor perceived indoor environmental quality (IEQ) can generate conflicts and experiences of injustice in workplaces. Therefore we examined whether the combined effect of poor IEQ and self-reported psychosocial stressors (low social support from supervisors and experiences of injustice) increase the risk of employees’ long-term sickness absence (more than 10 days) in comparison to employees who report only poor perceived IEQ and no psychosocial stressors. Methods: Using negative binomial modelling, we analysed a representative sample of the working-age population in Finland (N = 16,084) from the Finnish Quality of Work Life Surveys (FQWLS) from 1997, 2003, 2008 and 2013, combined with register-based follow-up data on employees’ long-term absences covering a period of one to three years after each FQWLS was collected. Results: After background variables were included in the model, employees who reported poor IEQ and low social support had 1.18 (incidents rate ratios; 95% CI 1.05–1.33) higher rates of long-term absence than those who reported poor IEQ and high support. Similarly, employees who reported poor IEQ and experiences of injustice had 1.31(incidents rate ratios; 95% CI 1.15–1.48) higher rates of absence than those who reported poor IEQ and no injustice. Conclusions: Employees who reported poor perceived IEQ and a psychosocial stressor had higher rates of long-term sickness absence one to three years later, in comparison with those who report only poor perceived IEQ and no psychosocial stressors. These findings demonstrate the importance of taking account of psychosocial stressors as well, when resolving indoor environmental problems.

Nursing resource team capacity planning using forecasting and optimization methods: A case study

AIM

To estimate the cost-minimizing size and skill mix of a nursing resource team (NRT).

BACKGROUND

Nurse absences can be filled by an NRT at lower hourly cost than staffing agencies or nurses working overtime, but an NRT must be appropriately sized to minimize total cost.

METHODS

Using all registered nurse (RN) absences at an academic teaching hospital from 1 October 2014 to 31 March 2018, we developed a generalized additive model (GAM) to forecast the weekly frequency of each of ten types of absence over 52 weeks. We used the forecasts in an optimization model to determine the cost-minimizing NRT composition.

RESULTS

The median weekly frequencies for the ten absence types ranged between 12 and 65.5. The root mean squared errors of the GAMs ranged between 4.55 and 9.07 on test data. The NRT dimensioned by the optimization model yields an estimated annual cost reduction of $277,683 (Canadian dollars) (7%).

CONCLUSIONS

The frequency of RN absences in a hospital can be forecasted with high accuracy, and the use of forecasting and optimization to dimension an NRT can substantially reduce the cost of filling RN absences.

IMPLICATIONS FOR NURSING MANAGEMENT

This methodology can be adapted by any hospital to optimize nurse staffing.

Transitioning from sickness absence to disability pension-the impact of poor health behaviours: a prospective Swedish twin cohort study

OBJECTIVES

To investigate the association between three poor health behaviours (current smoker, high consumption of alcohol and low physical activity levels) and the transition to disability pension (DP) among individuals who have recently been sickness absent. Furthermore, we aimed to explore whether having multiple poor health behaviours increased the risk of transitioning from sickness absence (SA) to DP.

DESIGN

Prospective twin cohort study.

SETTING

Sweden.

PARTICIPANTS

Twins aged 20-46 who had participated in a survey and been on SA (>14 days) in the year preceding baseline (date of answering the questionnaire).

MAIN OUTCOME MEASURE

Incident DP during the follow-up which ended on 31 December 2012 (mean 5.2 years). A national register with full coverage provided data on DP.

RESULTS

The Cox proportional-hazards regression analyses showed that current smokers had a higher risk of transitioning from SA to DP compared with never smokers (HR 1.76; 95% CI 1.08 to 2.84). Alcohol use and lack of physical activity as well as poor health behaviour sum score showed no significant associations.

CONCLUSIONS

Being a current smoker influences the transition from SA to DP. Although non-significant, there were indications that more physical activity and fewer poor health behaviours could reduce the risk of exiting the labour market through DP. Improving health behaviours among people on SA could be a valuable tool for preventing the transition to DP.

Working conditions and compensated sickness absence among nurses and care assistants in Sweden during two decades: a cross-sectional biennial survey study

OBJECTIVES

The aims of the study were to trace the patterns of work environment factors and compensated sickness absence (SA) among nurses and care assistants compared with other occupations and to compare SA among exposed and non-exposed nurses and care assistants.

DESIGN

A cross-sectional survey on work environment factors based on the biennial Swedish Work Environment Surveys 1991-2013, linked to longitudinal register data on SA 1993-2014.

PARTICIPANTS

The study included 98 249 individuals, stratified into nurses and care assistants (n=16 179) and a reference population including all other occupations (n=82 070).

OUTCOME MEASURE

Annual days of compensated SA (>14 days) 3 years after exposure years.

RESULTS

Nurses and care assistants had higher SA in 1993-2014 compared with all other occupations, and differences in background factors only partly explained this relationship. For both groups, exposure to physical work factors remained steady, but the number of exposed were 10%-30% higher among nurses and care assistants. Those exposed to heavy physical work and strenuous working postures had in most years significantly higher SA when compared with non-exposed (rate ratio range: 1.4-1.9). Exposure to high job demands increased 10%-25% in 1991-1999 among nurses and care assistants but became more stable in 2001-2013 and high proportions of high job demands coincided with the increase in SA in 1995-1999. Nurses and care assistants exposed to high job demands had for most years significantly higher SA than non-exposed (rate ratio range: 1.5-2.1). Low job control and low support from supervisors elevated SA significantly only for a few years.

CONCLUSIONS

Exposure to negative work factors among nurses and care assistants was weakly associated with variations in SA, but may be related to their higher level of SA when compared with other occupations. Improved physical and psychosocial working conditions may reduce the elevated SA level in these occupations.

Assessment of long-term sickness absence: content and face validity of a new questionnaire based on qualitative data from nominal groups

Background

Increasing rates of long-term sickness absence are a worldwide problem. Belgium is the first country in Europe that aims to screen its entire population of sick leavers (sick leave > 6 weeks) for the risk of long-term sickness absence in order to focus resources on the high-risk group and to provide adequate return-to-work support. Our aim was to investigate content and face validity of a newly designed questionnaire (Quickscan) using item prioritization of patients and professionals in the field of long-term sickness absence. This questionnaire was developed based on a review of the literature and existing instruments (Goorts et al, J Public Health Res 7:1419, 2018).

Methods

Qualitative data were collected using the nominal group technique. The data were gathered exploring factors that influence return-to work restrictions or opportunities.

Results

Participants indicated 20 out of 21 of the questionnaire factors as important reasons that might influence the return-to-work process. Additionally, 16 factors were discussed that were not yet included in the Quickscan but that might provide useful information on return-to-work issues, according to the participants. In the prioritization of items, we found considerable diversity among participants.

Conclusions

Our findings demonstrate the validity of the Quickscan items to ask patients about important return-to-work barriers or opportunities. However, additional factors were identified that may improve the assessment of risk for long-term sickness absence.

Job characteristics as risk factors for early retirement due to ill health: The Korean Longitudinal Study of Aging (2006-2014)

Objectives

To investigate work‐related factors that contribute to early retirement due to ill health (ERIH) in middle‐aged and elderly people in Korea.

Methods

Data were collected from a sample from the first through the fifth phases of the Korean Longitudinal Study of Aging which was conducted biennially from 2006 to 2014. ERIH was defined as the retirement of workers due to health problems before their scheduled or regular retirement age as reported in one of the follow‐up surveys. Three broad subdomains of working conditions were examined: work arrangements, physical working conditions, and job satisfactions. Hazard ratios of ERIH were estimated by Cox regression.

Results

Females, older people, unskilled manual workers, and day laborers were more likely to experience ERIH. In adjusted Cox proportional hazard models, the risk for ERIH in male workers was significantly higher among those with the following conditions: high physical demands, awkward posture, dissatisfaction with the working environment, and no industrial compensation insurance or retirement benefits. However, no significant association was found among female participants.

Conclusions

Occupational class, physical working conditions, job satisfaction, and work arrangement were the potential risk factors for ERIH among male workers in Korea. Moreover, our results revealed gender differences in the risk for ERIH.

Gender equality and sick leave among first-time parents in Sweden

Aims: To examine gender equality in the family and sick leave among first-time parents. Methods: Heterosexuals who became first-time parents between 2002 and 2009 (N = 223,332) were identified in national registers. Gender equality in the family was evaluated by parental insurance and income from gainful employment representing the domestic and work spheres respectively and was defined as each parent contributing 40-60% of the family total. The risk of a new medically certified sick-leave spell (>14 days) was evaluated by hazard ratio (HR) using the Cox proportional hazard regression, adjusted for demographic and socioeconomic factors. Results: Gender equality was associated with an increased risk of sick leave compared with traditional roles where women had the main responsibility in the domestic sphere and men in the work sphere (HR 1.30 in women and 1.19 in men). In addition, situations with one partner exposed to double burden or untraditional settings were associated with an increased risk. Conclusions: Equal sharing or taking the lion's share of paid work and domestic responsibilities were associated with an increased risk of sick leave among first-time parents in Sweden. Family-friendly policies are important for facilitating the life of dual earner families, but do not fully counteract the work-life demands of first-time parents.

Sickness-related absenteeism and risk factors associated among flower farm industry workers in Bishoftu town, Southeast Ethiopia, 2018: a cross-sectional study

Objective

The objective of this study was to investigate prevalence and factors affecting sickness absenteeism among flower farm industry workers in Bishoftu town, Ethiopia. A workplace-based cross-sectional study was conducted from March to April 2018. A sample of 444 participants were included using a stratified sampling technique. We performed binary logistic regression analysis to identify factors associated with sickness absenteeism.

Results

The entire sampled workers (N = 444) were interviewed. Of the respondents, 55.6% (N = 247) were females. The mean age was 24.2 (SD ± 6.6) years. About 54.5% (N = 242) [95% CI (50.2, 59.0)] of the participants indicated that they had experienced sickness absence of at least 3 consecutive working days in the past 12 months. A total of 1357 days were lost with an average duration of 5.6 days per worker per year. Female sex [AOR: 2.63; 95% CI (1.723, 4.036)], sickness presenteeism [AOR: 3.15; 95% CI (2.026, 4.904)], job dissatisfaction [AOR: 1.60; 95% CI (1.047, 2.462)] and drinking alcohol [AOR: 1.64; 95% CI (1.023, 2.621)] were associated factors. Sickness absenteeism had been found common in this study. Employers and policy designers need to formulate preventive schemes focusing on gender difference, job satisfaction, and the concomitant tackling of sickness absenteeism and presenteeism.

Quickscan assesses risk factors of long-term sickness absence: A cross-sectional (factorial) construct validation study

Objectives

The number of sick-listed employees has increased dramatically worldwide. Therefore, many countries aim to stimulate early and sustainable return to work opportunities to obtain better health outcomes and lower costs for disability pensions. To effectively orientate resources to patients with a high risk of not resuming work spontaneously, it is necessary to screen patients early in their sickness absence process. In this study, we validate “Quickscan”, a new instrument to assess return-to-work needs and to predict risks of long-term sick leave.

Methods

As part of the Quickscan validation process, we tested and compared the reliability and construct validity of the questionnaire in two different populations. First, we conducted a cross-sectional study in which the screening instrument was sent to sick-listed individuals in healthcare insurance. In a second cross-sectional study, sick-listed workers who consulted the occupational health physician for return-to-work assessment were asked to fill out the questionnaire. We compared both samples for descriptive statistics: frequencies, means and standard deviations. Reliability of the scales was calculated using Cronbach’s alpha. Confirmatory factor analysis was performed to evaluate the construct (factorial) validity of the studied scales using software package AMOS 24.

Results

The screening tool was shown to be an instrument with reliable scales (except for the perfectionism and health perception patient scale) in both populations. The construct validity was satisfactory: we found that the hypothesized measurement models with the theoretical factors fitted the data well in both populations. In the first sample, the model improved for scales concerning stressful life events and showed worse fit for person-related factors. Work-related factors and functioning factors both showed similar fit indices across samples. We found small differences in descriptive statistics, which we could explain by the differences in characteristics of both populations.

Conclusions

We can conclude that the instrument has considerable potential to function as a screening tool for disability management and follow-up of sick-leave, provided that some adaptations and validation tests are executed.

Pressão laboral, saúde e condições de trabalho dos professores da Educação Básica no Brasil

Morbidades em geral e licenças médicas são prevalentes no grupo dos professores da Educação Básica, cuja missão é essencial para a formação dos cidadãos. O objetivo foi produzir informações sobre as características demográficas, características da escola e da rede de ensino, e situação de saúde do grupo que percebeu pressão laboral. A amostra probabilística foi calculada por seleção aleatória simples, de maneira a representar o universo de 2.229.269 professores da Educação Básica no Brasil. O questionário multitemático foi respondido ao telefone. A pergunta que deu origem à variável desfecho, “Você tem dificuldade para faltar ao trabalho mesmo quando está com dor ou outro problema de saúde?”, foi testada e validada. A resposta viabilizou operacionalizar empiricamente o conceito de pressão laboral. Utilizou-se o teste do qui-quadrado de Pearson e o método de árvore de decisão na análise multivariada. O ajuste do modelo final foi avaliado por meio da estimativa de risco de classificação incorreta. As subdivisões da árvore indicam o apoio social como o primeiro determinante da pressão laboral, 55% relataram que têm dificuldade para faltar ao trabalho, mesmo quando estão com dor ou qualquer outro problema de saúde, 70% do grupo que avaliou sua saúde como ruim e muito ruim se sentiram pressionados para comparecer ao trabalho quando doentes ou com dor. Os fatores associados foram: fraco apoio social, ambiente agitado em função da indisciplina dos alunos e problema de saúde considerado como doença ocupacional. Diante das metas de valorização dos professores da Educação Básica, diferenciais de gênero e estilos de gestão, além da infraestrutura nas escolas, devem ser considerados.

Quickscan Assesses Risk of Long-Term Sickness Absence: A Cross-Sectional Validation Study

Objective:

Increasing long-term sickness absence in many countries asks for specific measures regarding return-to work.

Methods:

The risk of long-term sickness absence was assessed using a questionnaire containing work-related, function-related, stressful life-events-related, and person-related factors. Additionally, workers’ occupational health physician estimated the worker's chances for work resumption. Reliability, construct, and criterion validity of the questionnaire were measured.

Results:

Two hundred seventy-six patients and 35 physicians participated in the study. The reliability was satisfying (α > 0.70) for all scales, except for perfectionism (α = 0.62). The results of the CFAs showed that the hypothesized factor models fitted the data well. Criterion validity tests showed that eight predictors significantly related to the estimation of the occupational physicians (ρ < 0.05).

Conclusions:

The scales of the questionnaire are reliable and valid, and may be implemented to assess sick-listed workers at risk who might benefit from a rehabilitation program.

Work Disability Trajectories Among Individuals with a Sick-Leave Spell Due to Depressive Episode ≥ 21 Days: A Prospective Cohort Study with 13-Month Follow Up

Background Despite the increasing pattern of sick leave associated with depression in western countries, little is known about future work disability patterns among such sickness absentees. Aim To identify work disability (sick leave and disability pension) trajectories after the 21st day of a sick-leave spell due to depressive episode, and to investigate sociodemographic and morbidity characteristics of individuals in different trajectory groups. Methods This is a prospective cohort study using Swedish nationwide register data. We studied future work disability days (mean net days of sick leave and disability pension per month) among all individuals with a new sick-leave spell due to depressive episode (ICD-10 F32) ≥ 21 days during the first 6 months of 2010 (n = 10,327). Using group-based trajectory modeling, we identified work disability trajectories for the following 13 months. BIC value, group sizes, and average group probability were used to determine number of trajectories. Sociodemographic and morbidity characteristics were compared by χ² tests. Results We identified six trajectories of work disability: "decrease to 0 after 4 months" (43% of the cohort); "decrease to 0 after 9 months" (22%); "constant high" (11%); "decrease, then high increase" (9%); "slow decrease" (9%); and "decrease, then low increase" (6%). Those in the groups "constant high" and "decrease then high increase" were older and had the highest proportion with sick leave the year before. Conclusion A majority of the cohort (65%) had no work disability by the end of follow up. Sociodemographic and morbidity characteristics differed between trajectory groups among people on sick leave due to a depressive episode.

Sick leave and work-related accidents of social workers in Germany: an analysis of routine data

Purpose

The study aimed to explore the prevalence of sick leave and the risk of work-related accidents among German social workers and to describe causes and time trends in sick leave and accident claims.

Methods

A retrospective analysis of routine data was carried out. Aggregated sick leave data of 195,100 social workers from four health insurance funds and 3037 accident claims of social workers from an accident insurance institution were analysed. Causes of accidents were examined by statistics of the German Social Accident Insurance (DGUV). Sick leave rates per 100 insured person-years were calculated. Relative risks (RR) of accidents were calculated in a multivariate analysis for three occupational groups (social workers and therapists, caregivers in sheltered workshops and teachers in residential institutions) and compared to other health and welfare service workers.

Results

Mental disorders caused about one-fifth of the sick leave days of social workers. Sick leave due to mental disorders slightly increased in 2015 compared to 2012 (+ 3% and + 18%). Among the three subgroups of social workers, caregivers in sheltered workshops (RR 1.30; 95% CI 1.14–1.49) and teachers in residential institutions (RR 1.41; 95% CI 1.17–1.70) were at an increased risk of accidents at the workplace. Accidents were mostly caused by slipping (30%) and by violence (22%).

Conclusions

This study confirms that sick leave of social workers is frequently caused by mental disorders. Future studies could further examine differences between practice fields, long-term effects of work hazards and effective workplace interventions.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1370-z) contains supplementary material, which is available to authorized users.

The Implications of Psychological Symptoms for Length of Sick Leave

BACKGROUND

In this cross-sectional study, we aimed to determine the relation between sick leave duration, burnout symptoms, depression, anxiety, and somatization in a primary care setting.

METHODS

Patients receiving a sickness certificate in one of 14 participating primary care practices were consecutively asked by their primary care physician to fill in a questionnaire comprising the Maslach Burnout Inventory-General Survey (MBI-GS) and the Patient Health Questionnaire (PHQ) containing the depression (PHQ-9), somatization (PHQ-15), and anxiety (GAD-7) scales. The main diagnosis on the sickness certificate was documented by the issuing physician. A quasi-Poisson regression analysis was performed to estimate the influence of burnout symptoms, depression, and anxiety on length of sick leave.

RESULTS

225 patients participated, 122 (54.2%) were female; the mean age was 39.5 years. Length of sick leave correlated with emotional exhaustion (p = 0.005), depersonalization (p = 0.013), depression (p = 0.006), anxiety (p = 0.023), and somatization (p = 0.001). However, regression analysis revealed that the only predictors for length of sick leave were anxiety (exp[0.081] = 1.084; p = 0.013), age (exp[0.017] = 1.017; p = 0.041) and education (exp[- 0.508] = 0.602; p = 0:029). The pseudo R2 of the model was 0.25.

CONCLUSION

The impact of anxiety on burnout symptoms and sick leave days might have been underestimated so far. A holistic approach in patient centered communication should comprise the evaluation of psychosomatic comorbidity under consideration of the established concepts of depression and anxiety disorder to ensure adequate diagnostic and therapeutic management.

Effect of an eHealth Intervention to Reduce Sickness Absence Frequency Among Employees With Frequent Sickness Absence: Randomized Controlled Trial

Background

Frequent sickness absence—that is, 3 or more episodes of sickness absence in 1 year—is a problem for employers and employees. Many employees who have had frequent sickness absence in a prior year also have frequent sickness absence in subsequent years: 39% in the first follow-up year and 61% within 4 years. Moreover, 19% have long-term sickness absence (≥6 weeks) in the first follow-up year and 50% within 4 years. We developed an electronic health (eHealth) intervention, consisting of fully automated feedback and advice, to use either as a stand-alone tool (eHealth intervention–only) or combined with consultation with an occupational physician (eHealth intervention–occupational physician).

Objective

This study aimed to evaluate the effect of the eHealth intervention, with or without additional occupational physician consultation, to reduce sickness absence frequency for employees with frequent sickness absence, versus care as usual (CAU).

Methods

This study was a three-armed randomized controlled trial. Employees with frequent sickness absence received invitational letters, which were distributed by their employers. The primary outcome measure was the number of register-based sickness absence episodes 12 months after completing the baseline questionnaire. Secondary outcome measures were register-based total sickness absence days and self-assessed burnout, engagement, and work ability. In a process evaluation 3 months after baseline, we examined adherence to the intervention and additional actions such as general practitioner and occupational physician visit, communication with the manager, and lifestyle change.

Results

A total of 82 participants were included in the analyses, 21 in the eHealth intervention–only group, 31 in the eHealth intervention–occupational physician group, and 30 in the CAU group. We found no significant difference in sickness absence frequency between the groups at 1-year follow-up. Sickness absence frequency decreased in the eHealth intervention–only group from 3 (interquartile range, IQR 3-4) to 1 episode (IQR 0.3-2.8), in the eHealth intervention–occupational physician group from 4 (IQR 3-5) to 3 episodes (IQR 1-4), and in the CAU group from 3 (IQR 3-4) to 2 episodes (IQR 1-3). For secondary outcomes, we found no significant differences between the intervention groups and the control group. The process evaluation showed that only 3 participants from the eHealth intervention–occupational physician group visited the occupational physician on invitation.

Conclusions

Among employees with frequent sickness absence, we found no effect from the eHealth intervention as a stand-alone tool in reducing sickness absence frequency, nor on total sickness absence days, burnout, engagement, or work ability. This might be due to low adherence to the intervention because of insufficient urgency to act. We cannot draw any conclusion on the effect of the eHealth intervention tool combined with an occupational physician consultation (eHealth intervention–occupational physician), due to very low adherence to the occupational physician consultation. An occupational physician consultation could increase a sense of urgency and lead to more focus and appropriate support. As this was the first effectiveness study among employees with frequent sickness absence, strategies to improve recruitment and adherence in occupational eHealth are included.

Trial Registration

Netherlands Trial Register NTR4316; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4316 (Archived by WebCite at http://www.webcitation.org/713DHhOFU).

Sickness Absence of Nurses Working in Residential Elder Care: The Essential Role of Psychosocial Job Resources and Home Demands

OBJECTIVES

To elucidate the role and pathways of psychosocial home demands, psychosocial home resources, and psychosocial job resources in relation to sickness absence among nurses working in residential elder care.

METHODS

Longitudinal (SEM) analyses with bootstrapping with a 1 year follow-up among 365 nurses were performed. Survey data and registered sickness absence data were used.

RESULTS

A complete mediation model showed the best fit. More psychosocial job resources (β = -1.50) like "work schedule fit with private life" predicted less and more psychosocial home demands (β = 0.62) predicted more psychosomatic health complaints. The job resources and home demands predicted sickness absence duration and episodes 1-year later mediated through nurses' health.

CONCLUSIONS

More attention is needed for nurses' work schedule fit with private life and their home demands to potentially reduce health-related sickness absence among nurses working in residential elder care.

Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel

Purpose

We aim to extend current knowledge on associations between stressful work and sickness absence, first, by studying associations between ERI and sickness absence among full-time employees from various occupations, and second, by investigating if associations vary by age.

Methods

We use data from four waves of the German socio-economic panel (GSOEP), collected among men and women between 2006 and 2012, with 9418 observations. Stressful work is measured with a short form of the ERI questionnaire. We investigate an imbalance between effort and reward (ER ratio) as well as the two main components (“high effort” and “low reward”). Sickness absence is measured by self-reported number of sickness days (assessed the following year). After descriptive analyses, we estimate a series of multivariable regressions, including tests for interactions between age and work stress.

Results

Each of the three indicators of stressful work is related to higher number of sickness days, with except of “high effort” in case of men. Findings remain significant after adjusting for social position (income, education and occupational class) and health. In addition, for both men and women, associations were slightly higher among older workers, though interactions did not reach statistical significance.

Conclusion

Our findings support that stressful work is linked to sickness absence across a wide spectrum of jobs with varying incomes and educational levels, and also that associations are slightly more pronounced among older workers.

Electronic supplementary material

The online version of this article (10.1007/s00420-018-1298-3) contains supplementary material, which is available to authorized users.

Sick leave before and after the age of 65 years among those in paid work in Sweden in 2000 or 2005: a register-based cohort study

Objective

With pressure for older people to remain in work, research is needed on how people aged over 65 years fare in the labour market. However, few studies have focused on sick leave among older workers, especially those over the standard retirement age. This study investigated changes in sick-leave patterns among people aged over 65 years still in work.

Methods

All individuals in Sweden who turned 65 years old in 2000 or 2005 were followed from 1995 to 2010. The mean number of sick-leave days per year was measured for those who remained in paid work past the age of 65 years.

Results

Those over 65 years still working had fewer sick-leave days before the age of 65 years than those who retired. They also had fewer sick-leave days after 65 years than before. There were fewer socioeconomic differences after 65 years than before, but these differences were greater for workers over 65 years in the 2005 cohort.

Conclusions

Although there were more people over 65 years in paid work in 2005, sick-leave days and socioeconomic differences in sick leave were lower in this age group. Sick-leave days and socioeconomic differences in sick leave were greater in the 2005 cohort.

Sick leave among people in paid work after age 65: A Swedish population-based study covering 1995, 2000, 2005 and 2010

Aims: Extending working life into older age groups is discussed in many countries. However, there is no knowledge about how this affects rates of sick leave. The aim of this work was to investigate rates of sick leave among people in paid work after retirement age and if such rates have changed over time. Methods: Swedish nationwide register data on people aged >65 years and living in Sweden in 1995, 2000, 2005 and 2010 were analysed. All people with a sufficiently high work income to be eligible for public sick leave benefits were included. The proportions in paid work and compensated rates of sick leave for people aged 66–70 and ≥71 were analysed by sex, educational level, country of birth, living area, and employment type and sector. Results: The percentage of people in paid work at ages 66–70 years increased from <10% in 1995 to 24% in 2010 and among those aged ≥71 years from 2.7% in 1995 to 3.5% in 2010. The rates of sick leave among working people aged 66–70 years were 3.3% in 1995 and 2.4% in 2010 and for people aged ≥71 years the rates of sick leave were 2.2% in 1995 and 0.2% in 2010. Women had higher rates of sick leave than men in 2005 and 2010, but lower in 1995 and 2000. In 2010, the rates of sick leave were similar between employees and the self-employed, and higher among employees in the public sector than among employees in the private sector. Conclusions: Rates of sick leave among workers aged >65 years were lower in 2010 than in 1995, despite much higher rates of labour market participation in 2010.

Importance of social capital at the workplace for return to work among women with a history of long-term sick leave: a cohort study

BACKGROUND

The workplace is an essential source of social capital for many people; it provides mutual support and gives meaning to life. However, few prospective studies have thoroughly investigated the importance of aspects of social capital in the workplace. The aim of this study was to investigate the associations between aspects of social capital (social support, sense of community, and quality of leadership) at the workplace, and work ability, working degree, and vitality among women with a history of long-term sick leave from human service organizations.

METHODS

A longitudinal cohort study was performed among women with a history of long-term sick leave. The study started in 2005, and the women were followed up at 6 months, 1 year, and 6 years using self-reported questionnaires (baseline n = 283). Linear mixed models were used for longitudinal analysis of the repeated measurements of prospective degree of work ability, working degree, and vitality. Analyses were performed with different models; the explanatory variables for each model were social support, sense of community, and quality of leadership and time.

RESULTS

Social capital in terms of quality of leadership (being good at solving conflicts and giving high priority to job satisfaction), sense of community (co-operation between colleagues) and social support (help and support from immediate superiors and colleagues) increased the women's work ability score (WAS) as well as working degree over time. Additionally, social capital in terms of quality of leadership increased the women's vitality score over time.

CONCLUSIONS

A sustainable return-to-work process among individuals with a history of long-term sick leave, going in and out of work participation, could be supported with social support, good quality of leadership, and a sense of community at the workplace. The responsibility for the rehabilitation process can not be reduced to an individual problem, but ought to include all stakeholders involved in the process, such as managers, colleagues, health care services, and the social security agency.

Paid sick days and stay-at-home behavior for influenza

Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees' decisions to stay home from work for their own or a child's illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee's own or a child's illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee's own illness/injury, ILI, or influenza, and for a child's illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee's own or a child's illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child's illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and families.

Positive welfare state dynamics? Sickness benefits and sickness absence in Europe 1997-2011

Sickness absence is associated with great costs for individuals, companies and society at large. Influenced by neo-classical economic theory, policy advice has emphasized the role of sickness benefit programs for reducing sickness absence rates: too generous benefits without proper control will increase the number of recipients and prolong absence spells as well as possibly cause negative dynamic effects in the long term. This study provides an alternative interpretation of the relationship between sickness benefits and sickness absence. By combining an epidemiological approach to sickness absence and a resource-based approach to welfare, we argue that sickness benefits might be viewed as a "collective resource" that, by providing economic support during times of ill-health, might have positive health effects. Statistical analysis of short-term sickness absence using innovative methodological approaches and combined micro- and macro-level data for 21 EU countries over the period of 1992-2011 indicates that the long run effects of relatively generous sickness benefits is rather to reduce sickness absence. This result also has implications for sickness benefit reform: whereas benefit cuts to some extent may reduce absence in the short run, in the longer run such reforms may actually increase sickness absence rates.

High Job Demands, Job Strain, and Iso-Strain are Risk Factors for Sick Leave due to Mental Disorders: A Prospective Swedish Twin Study With a 5-Year Follow-Up

OBJECTIVE

To investigate whether psychosocial work environment and health behaviors are risk factors for sick leave due to mental disorders, and whether familial confounding (genetics and shared environment) explains the associations.

METHODS

Respondents (n = 11,729), given to complete a questionnaire in 2004 to 2006, were followed up approximately 5 years for sick leave spells due to mental disorders, using national registry data. Data were analyzed using logistic regression, and conditional logistic regression for twin pairs discordant for sick leave (cotwin control).

RESULTS

High job demands, job strain, and iso-strain were independent risk factors for sick leave due to mental disorders. Familial factors seem to be of importance in the associations between job support, smoking, a combination of unhealthy behaviors and sick leave.

CONCLUSIONS

Improving the psychosocial work environment may be effective in preventing sick leave due to mental disorders.

Gender differences in the duration of non-work-related sickness absence episodes due to musculoskeletal disorders

BACKGROUND

There is wide evidence that women present longer duration of sickness absence (SA) than men. Musculoskeletal disorders are influenced by gender due to the sexual division of work.

METHODS

354 432 episodes of non-work-related SA due to musculoskeletal disorders, which were registered in Catalonia between 2005 and 2008, were selected. The outcome variable was the duration of SA. Frailty survival models, stratified by sex and adjusted for explanatory variables (age, employment status, case management, economic activity and repeated episode), were fitted to study the association between each variable and the duration of SA, obtaining HRs.

RESULTS

Women presented longer SA episodes than men in all variable categories. A trend from shorter to longer duration of SA with increasing age was observed in men, whereas in women, it had a fluctuating pattern. Analysing most frequent diagnostic subgroups from the sample, only 'non-specific lumbago' and 'sciatic lumbago' showed these age patterns. Frailty survival models applied to these 2 subgroups confirmed the described age patterns in SA duration.

CONCLUSIONS

Women have longer non-work-related SA due to musculoskeletal disorders than men. However, while men have longer absences as their age increases, in women some older groups have shorter absences than younger ones. These findings could be explained by gender differences in the interaction between paid work and family demands. Our results highlight the need for continued research on SA from a gender perspective, in order to improve management of SA in terms of clinical practice and public policies.

Educational differences in sickness absence trends among young employees from 2002 to 2013 in Helsinki, Finland

OBJECTIVE

Socioeconomic differences in sickness absence (SA) are well established among older employees but poorly understood among the young. Our aim was to examine 12-year trends in educational differences in SA among young female and male employees, and to assess the magnitude of the differences.

DESIGN

We examined annual SA spells. The data were obtained from the employer's registers and linked to Statistics Finland's register data on completed education and qualifications. Education was classified into four hierarchical groups. Joinpoint regression models were used to identify turning points in SA trends. The magnitude of the relative educational differences was estimated in accordance with the relative index of inequality for 2002, 2008 and 2013.

SETTING

Employees of the City of Helsinki, Finland, in 2002-2013.

PARTICIPANTS

The analyses covered female and male employees aged 25-34 years: employees aged 35-54 years were used as a reference group.

OUTCOME

SA spells.

RESULTS

An educational gradient emerged among younger and older women and men. SA spells increased in the early 2000s, and downward turning points were located in 2007-2010 in all educational groups among women and in most groups among men. The magnitude of the differences remained broadly stable among younger women from 2002 to 2013, and decreased slightly among older women and more strongly among younger and older men. The educational differences were greater among men than women in the early 2000s, but similar among both at the end of the study period.

CONCLUSIONS

The changes in SA spells may reflect the economic downturn started in 2008 and resulting job insecurity. Early preventive measures aimed at reducing educational differences in SA should be focused at an early stage on those with low levels of education in particular.

Social support outside work and return to work among women on long-term sick leave working within human service organizations

AIM

To investigate the relationships between return to work and social support outside work among women on long-term sick leave from human service organizations.

BACKGROUND

Work is an important part of life and is, in general, considered to be supportive of health and wellbeing. Few studies have thoroughly investigated the importance of aspects of social support outside work for return to work.

METHODS

A cohort of women on long-term sick leave was followed with questionnaires from 2005 to 2012.

RESULTS

The availability of social attachment increased the women's work ability, return to work, and vitality significantly more over time. There were positive relationships between return to work and seeking support in terms of emotional support and comfort and expressing unpleasant feelings.

CONCLUSIONS

Important resources to increase return to work can be found in factors outside work, such as close social relationships and support seeking. Thus, it is important to take the woman's whole life situation into account and not focus solely on aspects related to the workplace.

Return to work from long-term sick leave: a six-year prospective study of the importance of adjustment latitudes at work and home

PURPOSE

The aim was to investigate the long-term importance of adjustment latitude for increased work ability and return to work among female human service workers on long-term sick leave.

METHODS

A cohort of female human service workers on long-term sick leave (>60 days) was given a questionnaire four times (0, 6, 12, 60 months). Linear mixed models were used for longitudinal analysis of the repeated measurements of work ability and return to work.

RESULTS

Having a higher level of adjustment latitude was associated with both increased work ability and return to work. Adjustments related to work pace were strongly associated with increased work ability, as were adjustments to the work place. Having individual opportunities for taking short breaks and a general acceptance of taking short breaks were associated with increased work ability. At home, a higher level of responsibility for household work was related to increased work ability and return to work. Individuals with possibilities for adjustment latitude, especially pace and place at work, and an acceptance of taking breaks had greater increased work ability over time and a greater work ability compared with individuals who did not have such opportunities.

CONCLUSIONS

This study highlights the importance of opportunities for adjustment latitude at work to increase work ability and return to work among female human service workers who have been on long-term sick leave. The results support push and pull theories for individual decision-making on return to work.

The Prognostic Value of the Work Ability Index for Sickness Absence among Office Workers

BACKGROUND

The work ability index (WAI) is a frequently used tool in occupational health to identify workers at risk for a reduced work performance and for work-related disability. However, information about the prognostic value of the WAI to identify workers at risk for sickness absence is scarce.

OBJECTIVES

To investigate the prognostic value of the WAI for sickness absence, and whether the discriminative ability differs across demographic subgroups.

METHODS

At baseline, the WAI (score 7-49) was assessed among 1,331 office workers from a Dutch financial service company. Sickness absence was registered during 12-months follow-up and categorised as 0 days, 0<days<5, 5≤days<15, and ≥15 days in one year. Associations between WAI and sickness absence were estimated by multinomial regression analyses. Discriminative ability of the WAI was assessed by the Area Under the Curve (AUC) and Ordinal c-index (ORC). Test characteristics were determined for dichotomised outcomes. Additional analyses were performed for separate WAI dimensions, and subgroup analyses for demographic groups.

RESULTS

A lower WAI was associated with sickness absence (≥15 days vs. 0 days: per point lower WAI score OR=1.27; 95%CI 1.21-1.33). The WAI showed reasonable ability to discriminate between categories of sickness absence (ORC=0.65; 95%CI 0.63-0.68). Highest discrimination was found for comparing workers with ≥15 sick days with 0 sick days (AUC=0.77) or with 1-5 sick days (AUC=0.69). At the cut-off for poor work ability (WAI≤27) the sensitivity to identify workers at risk for ≥15 sick days was 7.5%, the specificity 99.6%, and the positive predictive value 82%. The performance was similar across demographic subgroups.

CONCLUSIONS

The WAI could be used to identify workers at high risk for prolonged sickness absence. However, due to low sensitivity many workers will be missed. Hence, additional factors are required to better identify workers at highest risk.

Interrelationships between education, occupational class and income as determinants of sickness absence among young employees in 2002-2007 and 2008-2013

Background

A low socioeconomic position (SEP) is consistently associated with ill health, sickness absence (SA) and permanent disability, but studies among young employees are lacking. We examined the interrelationships between education, occupational class and income as determinants of SA among 25-34-year-old employees. We also examined, whether the association between SEP and SA varied over time in 2002–2007 and 2008–2013.

Methods

The analyses covered young, 25-34-year-old women and men employed by the City of Helsinki over the time periods 2002–2007 and 2008–2013. Four-level education and occupational class classifications were used, as well as income quartiles. The outcome measure was the number of annual SA days.

Results

Education had the strongest and most consistent independent association with SA among women and men in both periods under study. Occupational class had weaker independent and less consistent association with SA. Income had an independent association with SA, which strengthened over time among the men. The interrelationships between the SEP indicators and SA were partly explained by prior or mediated through subsequent SEP indicators. Socioeconomic differences followed only partially a gradient for occupational class and also for income among men.

Conclusions

Preventive measures to reduce the risk of SA should be considered, especially among young employees with a basic or lower-secondary education.

Electronic supplementary material

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Impact of changes in medical condition burden index and stress on absenteeism among employees of a US utility company

Purpose

– The purpose of this paper is to investigate the impact of changes of medical condition burden index (MCBI) and stress on absenteeism and discuss implications for policy/program design.

Design/methodology/approach

– Sample: US utility employees that participated in Health Risk Appraisals (HRA) during 2009 and 2010 (n=3,711). Methods: the MCBI was created by summing number of medical conditions. Absenteeism was measured from administrative records. Change in MCBI and stress and impact on absenteeism was assessed according to incremental change, by low/high categorizations, and by using multivariate regression.

Findings

– Incrementally, greater changes in MCBI or stress generally resulted in corresponding absenteeism change. For both MCBI and stress, high categories were associated with greater absenteeism compared to those in low categories. Those remaining in the low MCBI category decreased absenteeism (−0.10 days/year; p=0.01). Changes from low to high MCBI resulted in increased absenteeism (+0.12 days/year; p=0.04. Changes in stress from low to high or from high to low categories resulted in concurrent changes in absenteeism (+0.21 days/year; p=0.04 and −0.31 days/year; p=0.01, respectively). Regression analyses indicated the interaction between stress and MCBI as a significant contributor to absenteeism change.

Research limitations/implications

– Conclusions: MCBI, stress and their interaction appear to be direct determinants of absenteeism. Companies should consider both physical and emotional health simultaneously in program interventions in order to reduce absenteeism.

Originality/value

– Unlike most studies illustrating cross-sectional relationships, this study shows how changes in stress and medical conditions relate to changes in absenteeism. The interaction between MCBI and stress in this context is also a novel addition.