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.

 

     

Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study.

OBJECTIVES. This study sought to examine the association between the psychosocial work environment and subsequent rates of sickness absence. METHODS. The analyses were based on a cohort of male and female British civil servants (n=9072). Rates of short spells (<or=7 days) and long spells (>7 days) of sickness absence were calculated for different aspects of the psychosocial work environment, as measured by self-reports and personnel managers' ratings (external assessments). RESULTS. Low levels of work demands, control, and support were associated with higher rates of short and long spells of absence in men and, to a lesser extent, in women. The differences were similar for the self-reports and external assessments. After adjustment for grade of employment, the differences were diminished but generally remained significant for short spells. The combination of high demands and low control was only associated with higher rates of short spells in the lower grades. CONCLUSIONS. The psychosocial work environment predicts rates of sickness absence. Increased levels of control and support at work could have beneficial effects in terms of both improving the health and well-being of employees and increasing productivity.     

Influence of change in psychosocial work characteristics on sickness absence: The Whitehall II Study

OBJECTIVES: To study the influence of change in self perceived psychosocial work characteristics on subsequent rates of sickness absence. METHODS: Prospective cohort study of British civil service employees. Job control, job demands, and work social supports were measured in 1985/88 and in 1991/93. Analyses included 3817 British civil servants with sickness absence records at baseline (1985-89) and for two follow up periods, early (1994-95) and later follow up (1996-98). RESULTS: Change in work characteristics predicted subsequent incidence of long spells of sickness absence (>7 days) in the early follow up period after adjustment for covariates including baseline work characteristics, health status, and sickness absence. Adjusted rate ratios were 1.23 (95% CI 1.03 to 1.46) for decreased compared with stable decision latitude; 1.17 (95% CI 1.01 to 1.36) for increased compared with stable job demands and 0.79 (95% CI 0.67 to 0.93) for increased compared with stable work social support. These associations were also seen in a sub-sample who did not change employment grade. In the later follow up period, associations between work change and long spells of sickness absence were similar for decision latitude, less pronounced for job demands, and no longer apparent for social supports. Changes in work characteristics were not associated with subsequent short spells of sickness absence (相似文献   

Unfairness and health: evidence from the Whitehall II Study

OBJECTIVE: To examine the effects of unfairness on incident coronary events and health functioning. DESIGN: Prospective cohort study. Unfairness, sociodemographics, established coronary risk factors (high serum cholesterol, hypertension, obesity, exercise, smoking and alcohol consumption) and other psychosocial work characteristics (job strain, effort-reward imbalance and organisational justice) were measured at baseline. Associations between unfairness and incident coronary events and health functioning were determined over an average follow-up of 10.9 years. PARTICIPANTS: 5726 men and 2572 women from 20 civil service departments in London (the Whitehall II Study). MAIN OUTCOME MEASURES: Incident fatal coronary heart disease, non-fatal myocardial infarction and angina (528 events) and health functioning. RESULTS: Low employment grade is strongly associated with unfairness. Participants reporting higher levels of unfairness are more likely to experience an incident coronary event (HR 1.55, 95% CI 1.11 to 2.17), after adjustment for age, gender, employment grade, established coronary risk factors and other work-related psychosocial characteristics. Unfairness is also associated with poor physical (OR 1.46, 95% CI 1.20 to 1.77) and mental (OR 1.54, 95% CI 1.19 to 1.99) functioning at follow-up, controlling for all other factors and health functioning at baseline. CONCLUSIONS: Unfairness is an independent predictor of increased coronary events and impaired health functioning. Further research is needed to disentangle the effects of unfairness from other psychosocial constructs and to investigate the societal, relational and biological mechanisms that may underlie its associations with health and heart disease.     

Self-reported economic difficulties and coronary events in men: evidence from the Whitehall II study

BACKGROUND: Numerous studies have demonstrated social inequalities in coronary heart disease using a variety of measures of social position. In this study we examine associations between persistent economic difficulties and serious coronary events. Our aim is to assess whether these associations are (i) explained by other measures of socioeconomic status, and (ii) mediated by psychosocial, behavioural and biological factors. METHODS: The data come from 5021 middle-aged, white-collar men in the Whitehall II study. Self-reported household financial problems, measured at baseline (1985-88) and Phase 3 (1991-93), were used to construct a five-category score of persistent economic difficulties. Associations between economic difficulties and incident coronary events were determined over an average follow-up of 7 years. Other socioeconomic, psychosocial, behavioural and biological explanatory variables were obtained from the Phase 3 questionnaire and clinical examination. RESULTS: Age-adjusted Cox regression analyses demonstrated steep gradients in the incidence of coronary events with economic difficulties. The relative hazard between the bottom and the top of the difficulties hierarchy was 2.5 (95% confidence intervals (CI) 1.2-5.2) for fatal and non-fatal myocardial infarction (MI), 2.1 (1.3-3.6) for MI plus definite angina and 2.8 (1.9-4.2) for total coronary events. Adjustment for other markers of socioeconomic position, early life factors, psychosocial work environment characteristics and health-related behaviours had little effect, while adjustment for the biological factors reduced the association between difficulties and coronary events by 16-24%. CONCLUSION: We have demonstrated an economic difficulties gradient in coronary events in men that is independent of other markers of socioeconomic position and appears to be only partially mediated by well-known risk factors in mid-life.     

Leisure activities and cognitive function in middle age: evidence from the Whitehall II study

OBJECTIVES: To test the hypothesis of a positive association, independent of social position, between participation in leisure activities and cognitive function in middle age. The nature of this relation is explored by first classifying leisure activities as entailing high or low cognitive effort, and then classifying them as entailing individual or social activities. SETTING: London based office staff (Whitehall II study) in 20 civil service departments at baseline. METHODS: Data are from the fifth wave of data collection (phase 5) of a prospective cohort study, collected through clinical examination and a self administered questionnaire. Firstly, hierarchical multiple regression was used to examine age and socioeconomic status (SES) adjusted effect of each leisure activity on cognition. Then structural equation models were used to examine the effects of two categories of leisure activities-activities entailing high or low cognitive effort and social or individual activities. All analyses are cross sectional. RESULTS: There was an age and SES adjusted association between participation in leisure activities and cognitive function. More specifically, leisure activity entailing high cognitive effort or social interaction was associated with better cognitive ability. CONCLUSIONS: Participation in cognitively complex or social leisure activities has an independent association with adult cognition, suggesting that seeking mental stimulation may have a beneficial effect on cognition in middle age.     

Alcohol consumption and sickness absence: evidence from microdata

Background: Aggregate time-series evidence has shown that overallper capita alcohol consumption is associated with sickness absence.This study re-examines the relationship between alcohol consumptionand sickness absence by using individual-level microdata andmethods that yield results which are less likely to be due tospurious correlations. Methods: Data on sickness absence andalcohol consumption for 18 Finnish regions over the period 1993–2005was used. Sickness absence was measured as the number of sicknessabsence days during 1 year. Alcohol consumption was measuredas the number of alcohol drinks consumed per week. The individual-levelrelationship between alcohol consumption and sickness absencewas estimated by using Poisson regression models. Unobserveddeterminants of lifestyle behaviours associated with the regionand survey year were controlled for. Personal characteristicsas well as the clustering of observations by regions were alsotaken into account. Results: The estimates show that alcoholconsumption is associated with sickness absence. The positiverelationship between alcohol consumption and sickness absenceis particularly pronounced for low-educated males. Conclusions:Aggregate time-series evidence for the relationship betweenalcohol consumption and sickness absence is confirmed by usingindividual-level microdata. The policy lesson is that it isimportant to take into account the effects of alcohol consumptionon the prevalence of sickness absence (i.e. labour supply onan intensive margin) when one is considering the level of taxationof alcoholic beverages.     

Are risk factors for atherothrombotic disease associated with back pain sickness absence? The Whitehall II Study

STUDY OBJECTIVE: To explore the previously stated hypothesis that risk factors for atherothrombotic disease are associated with back pain. DESIGN: Prospective (mean of four years of follow up) and retrospective analyses using two main outcome measures: (a) short (< or = 7 days) and long (> 7 days) spells of sickness absence because of back pain reported separately in men and women; (b) consistency of effect across the resulting four duration of spell and sex cells. SETTING: 14 civil service departments in London. PARTICIPANTS: 3506 male and 1380 female white office-based civil servants, aged 35-55 years at baseline. MAIN RESULTS: In age adjusted models, low apo AI was associated with back pain across all four duration-sex cells and smoking was associated across three cells. Six factors were associated with back pain in two cells: low exercise and high BMI, waist-hip ratio, triglycerides, insulin and Lp(a). On full adjustment (for age, BMI, employment grade and back pain at baseline), each of these factors retained a statistically significant effect in at least one duration-sex cell. Triglycerides were associated with short and long spells of sickness absence because of back pain in men in fully adjusted models with rate ratios (95% confidence intervals) of 1.53 (1.1, 2.1) and 1.75 (1.0, 3.2) respectively. There was little or no evidence of association in age adjusted models with: fibrinogen, glucose tolerance, total cholesterol, apoB, hypertension, factor VII, von Willebrand factor, electrocardiographic evidence of coronary heart disease and reported angina. CONCLUSIONS: In this population of office workers, only modest support was found for an atherothrombotic component to back pain sickness absence. However, the young age of participants at baseline and the lack of distinction between different types of back pain are likely to bias the findings toward null. Further research is required to ascertain whether a population sub-group of atherothrombotic back pain can be identified.     

Sickness absence as a measure of health status and functioning: from the UK Whitehall II study.

STUDY OBJECTIVE--To investigate the relationship between self reported health status and sickness absence. DESIGN--Analysis of questionnaire and sickness absence data from the first phase of the Whitehall II study--a longitudinal study set up to investigate the degree and causes of the social gradient in morbidity and mortality. SETTING--London offices of 20 civil service departments. PARTICIPANTS--Altogether 6895 male and 3413 female civil servants aged 35-55 years. Analysis was conducted on 88% of participants who had complete data for the present analysis. MAIN RESULTS--A strong inverse relation between the grade of employment (measure of socioeconomic status) and sickness absence was observed. Men in the lowest grade had rates of sickness absence six times higher than those in the highest grade. For women the corresponding differences were two to five times higher. In general, the longer the duration of absence, the more strongly did baseline health predict rates of absence. However, the health measures also predicted shorter spells, although to a lesser extent. Job satisfaction was strongly related to sickness absence with higher rates in those who reported low job satisfaction. After adjusting for health status the association remained for one to two day absences, but was greatly reduced for absences longer than three days. CONCLUSION--There was a strong association between ill health and sickness absence, particularly for longer spells. The magnitude of the association may have been underestimated because of the strength of the association between grade of employment and sickness absence. It is proposed that sickness absence be used as an integrated measure of physical, psychological, and social functioning in studies of working populations.     

Sickness absence poses a threat to the Swedish Welfare State: a cross-sectional study of sickness absence and self-reported illness

Background  

The increasing cost of public social sickness insurance poses a serious economic threat to the Swedish welfare state. In recent years, expenditures for social insurance in general, as well as social sickness insurance in particular, have risen steeply in Sweden. This cross-sectional study analyzed the association between sickness absence (SA) and self-reported reduced working capacity due to a longstanding illness (>3 months), as well between SA and a number of other health problems.     

Birth weight, components of height and coronary heart disease: evidence from the Whitehall II study

BACKGROUND: Previous studies have suggested that shorter leg length, not trunk length, may explain the inverse association between height and coronary heart disease (CHD) risk. However, investigation of the importance of birth weight for these associations has been limited. This study examines associations of measures of stature and birth weight with CHD risk factors (measures of blood pressure and lipids, 2 h glucose, waist-hip ratio and fibrinogen) and incident non-fatal coronary events in middle age. METHODS: Data were derived mostly from the Phase 5 (1997-99) clinical screening of the Whitehall II study of British civil servants. The main cross-sectional analyses included 1084 women and 2290 men with complete data. RESULTS: In women total height and leg length were the measures that tended to be most strongly associated with CHD risk factors, while in men leg length demonstrated the closest associations. Although associations between trunk length and CHD risk factors were weaker, trunk length was the component of height that appeared to be most closely associated with coronary events. Associations between birth weight and CHD risk factors and coronary events were generally weaker than for any measure of stature. Adjustment for birth weight had little effect on associations between components of stature and CHD risk factors or events. CONCLUSION: Findings from this relatively privileged cohort confirmed that shorter leg length underlies the inverse association between height and CHD risk factors in middle-aged women and men. Furthermore, in this study population shorter trunk length was more closely associated with incident, non-fatal coronary events.     

Association of CRP and IL-6 with lung function in a middle-aged population initially free from self-reported respiratory problems: the Whitehall II study

To assess whether two inflammatory markers, C-reactive protein (CRP) and interleukin-6 (IL-6), and change in their concentrations over 12 years, are associated with lung function (FVC and FEV₁) 12 years after baseline. Data are from over 1,500 participants free from self-reported respiratory problems in a large-scale prospective cohort study of white-collar male and female civil servants. CRP and IL-6 measured at baseline (1991–1993) and follow-up (2002–2004) and FVC and FEV₁, measured at follow-up. Results adjusted for sociodemographic and anthropometric characteristics, health behaviours, biological factors, chronic conditions and medications, and corrected for short-term variability in CRP and IL-6 concentrations. Higher baseline levels of CRP and IL-6 were strongly associated with lower FVC and FEV₁, independent of potential confounders. A 10% increase serum CRP from baseline to follow-up was associated with lower values of FVC and FEV₁ at follow-up, 4.7 and 3.0 ml, respectively. The corresponding values for a 10% increase in IL-6 were 12.6 ml for FVC and 7.3 ml for FEV₁. Systemic low-grade inflammation is associated with only slightly poorer pulmonary function in a population free from self-reported respiratory problems 12 years earlier. These data provide evidence linking inflammation to adverse outcomes beyond cardiovascular disease. Interventions targeting inflammation may prevent lung function impairment.     

Controlling sickness absence: a study of changes in the Danish sickness absence legislation since 1973

OBJECTIVES: To outline the principles underlying changes overtime in entitlement to sickness absence benefit in Denmark. METHODS: The Danish sickness benefit scheme during the past 30 years has been studied based on a comprehensive review of the Sickness Benefit Act from 1973, and all later amendments to the act. RESULTS: Entitlement to sickness benefit in Denmark has undergone considerable changes during the past 30 years. The guiding principles of the reforms have been financial savings in combination with an assumption that human behaviour can be controlled through bureaucratic administration with focus on monitoring and evaluation. CONCLUSIONS: The Sickness Benefit Act was initially based on a broad concept of disease but the implementation underwent major changes. In the 1970s and 1980s entitlement to benefit depended very much on medical diagnosis. This practice changed and today's policy is to some extent a return to the biopsychosocial approach in the sense that the citizen is not regarded a passive victim of disease but an active player in influencing own working capacity. Added to this is, however, a new element of much tighter control leaving less room for autonomy.     

Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study

OBJECTIVES: We examined the association between physical activity and cognitive functioning in middle age. METHODS: Data were derived from a prospective occupational cohort study of 10308 civil servants aged 35-55 years at baseline (phase 1; 1985-1988). Physical activity level, categorized as low, medium, or high, was assessed at phases 1, 3 (1991-1994), and 5 (1997-1999). Cognitive functioning was tested at phase 5, when respondents were 46-68 years old. RESULTS: In both prospective (odds ratio [OR] = 1.65; 95% confidence interval [CI]=1.30, 2.10) and cross-sectional (OR=1.79; 95% CI=1.38, 2.32) analyses, low levels of physical activity were a risk factor for poor performance on a measure of fluid intelligence. Analyses aimed at assessing cumulative effects (summary of physical activity levels at the 3 time points) showed a graded linear relationship with fluid intelligence, with persistently low levels of physical activity being particularly harmful (OR=2.21; 95% CI=1.37, 3.57). CONCLUSIONS: Low levels of physical activity are a risk factor for cognitive functioning in middle age, fluid intelligence in particular.     

Short-term absence from industry: II Temporal variation and inter-association with other recorded factors

Froggatt, P. (1970).Brit. J. industr. Med.,27, 211-224. Short-term absence from industry. II. Temporal variation and inter-association with other recorded factors. This paper (a) extends the previous analysis (Froggatt, 1970b) of short-term absence from work among groups of male and female industrial personnel and clerks in government service, and (b) studies other recorded variables, particularly lateness, long-term sickness absence, and passes from work both `medical' and `works'.

Multiple regression shows one-day absences to be generally associated with two-day absences, lateness, and medical passes but independent of works passes and long-term sickness absence; and two-day absences to be generally associated with one-day absences and long-term sickness absence but not with lateness or passes from work. Higher order correlations show lateness and works passes, medical passes and works passes, and lateness and age to be (weakly) associated, the last negatively.

Irrespective of season, one-day absences were consistently most prevalent on Monday and least so on Friday, with a subsidiary peak for the male groups on Wednesday; two-day absences - as measured by the day each absence starts - were consistently most prevalent on Monday and least so on Thursday (Friday was omitted) and during the summer months. Medical passes were generally independent of the day of the week and the period of the year; lateness was greatest on Friday and during the winter, though the increase was slight; but works passes were relatively prevalent on Friday.

Correlation and regression show the association between numbers of one-day absences taken in two periods of time (each one year) to be marked (r = 0·5 to 0·7), unaffected by transforming to normal functions, and explicable on a linear hypothesis, but the value of r to increase as the periods of time increase and to decrease as the interval between the periods of time lengthens. Similar analyses for two-day absences show r = 0·25 to 0·55, acceptance of a linear hypothesis, and a suggestion that the value of r may increase as the periods of time increase and as the interval between them shortens. More limited examination shows corresponding values of r (for contiguous years) to be of the order 0·25 for medical passes, 0·60 for works passes, but > 0·80 for lateness.

Values of r between each of these factors in turn for all possible pairs of days of the week are reasonably consistent and show r of the order 0·35 for one-day absences, 0·25 for medical passes, 0·40 for works passes, and 0·80 for lateness (values for two-day absences are irregular and in the range 0 to 0·4). The consistency of lateness experience over days and years is very marked, the correlations being among the highest recorded for any event involving human behaviour.

The importance and application of the findings are briefly discussed; detailed consideration is reserved for the third and last paper.

     

Physical activity and cause-specific mortality in men: further evidence from the Whitehall study

Reports of studies relating physical activity to stroke and cancer sub-types indicate inconsistent findings. Some are hampered by low statistical power, owing to a low number of events, and a failure to adjust for potential confounding variables. The purpose of this study was to relate physical activity to 12 mortality endpoints in a prospective cohort study of 11,663 men aged 40–64 years who responded to an enquiry about travel activity during a baseline medical examination conducted between 1967 and 1969. During 25 years of follow-up there were 4672 deaths. Travel activity was inversely related to mortality attributable to all-causes, coronary heart disease, respiratory disease and lung cancer, whereas the association with stroke was positive. There was evidence for attenuation of some of these associations on adjustment for potentially confounding variables. Our simplistic measure of physical activity may, in part, explain the weak associations seen.     

Sickness absence in the Whitehall II study, London: the role of social support and material problems.

STUDY OBJECTIVE--To investigate the role of social supports, social networks, and chronic stressors: (i) as predictors of sickness absence; and (ii) as potential explanations for the socioeconomic gradient in sickness absence. DESIGN--A prospective cohort study (Whitehall II study) with sociodemographic factors, health and social support measured at baseline, and spells of sickness absence measured prospectively. SETTING--Twenty London based non-industrial departments of the British civil service. PARTICIPANTS--Participants were civil servants (n = 10,308), aged 35-55 years at baseline, of whom 67% (6895) were men and 33% (3413) were women. The overall response rate for Whitehall II was 73% (74% for men and 71% for women). The analysis is based on 41% of the sample who had data on reasons for sickness absence and were administered all social support questions. Only 4.3% of participants did not complete all necessary questions and were excluded. MEASUREMENTS AND MAIN RESULTS--High levels of confiding/emotional support from the "closest person" predicted higher levels of both short and long spells of sickness absence. After adjusting for baseline physical and psychological health the effects were increased, suggesting that high levels of confiding/emotional support may encourage illness behaviour rather than generate illness. Social network measures showed a consistent but less striking pattern. Increased levels of negative aspects of social support resulted in higher rates of sickness absence. Material problems strongly predicted sickness absence, but the effect was diminished once adjustment for the covariables was made, suggesting that health status may be functioning as an intervening variable between chronic stressors and sickness absence. In addition, social support may buffer the effects of chronic stressors. Social support did not contribute to explaining the gradient in sickness absence by employment grade beyond that explained by the baseline covariables. CONCLUSIONS--Sickness absence from work is a complex phenomenon, combining illness and coping behaviours. High levels of confiding/emotional support, although not entirely consistent across samples, may either encourage people to stay at home when they are ill or may be accompanied by more social obligations at home prolonging sickness absence. Negative aspects of close relationships may jeopardize health and hence increase sickness absence.