Employee worktime control moderates the effects of job strain and effort-reward imbalance on sickness absence: the 10-town study

STUDY OBJECTIVE: To examine whether the effects of work stress on sickness absence vary by the level of control the employees have over their working times. DESIGN: Prospective cohort study. A survey of job strain, effort-reward imbalance, and control over daily working hours and days off was carried out in 2000-01. The survey responses were linked with registered data on the number of medically certified (>3 days) sickness absences from one year before the survey until the end of 2003. The mean follow up period was 28.2 (SD 8.1) months. Adjustments were made for demographics and behavioural health risks. Aggregated measures of worktime control according to workplaces were used to control for differences in reactivity and response style. SETTING: Ten towns in Finland. PARTICIPANTS: 16 139 public sector employees who had no medically certified sickness absences in the year preceding the survey. MAIN RESULTS: Among the women, individually measured control over daily working hours and days off moderated the association between work stress and sickness absence. The combination of high stress and good worktime control was associated with lower absence rates than a combination of high stress and poor worktime control. This finding was replicated in the analyses using workplace aggregates of worktime control. Among the men, the findings were less consistent and not replicable using aggregated measures of worktime control. CONCLUSIONS: Good control over working times reduces the adverse effect of work stress on sickness absence especially among female employees.     

Contingent employment, health and sickness absence.

OBJECTIVES: This study explored the health and sickness absences of contingent employees. METHODS: Analyses of self-reported health and recorded spells of sickness absence were based on a cohort of 5650 employees (674 men, 4976 women) in 10 Finnish hospitals. RESULTS: After adjustment for demographic and work-related characteristics, contingent employees had a better self-rated health status [odds ratio 0.76, 95% confidence interval (95% CI) 0.62-0.94 of poor or average health status]. There were no differences in the prevalence of diagnosed chronic diseases and minor psychiatric morbidity between the groups. After adjustment for self-rated health and confounding, female, but not male, contingent employees had a lower rate of self-certified (1-3 days) sickness absences than permanent employees (rate ratio 0.90, 95% CI 0.85-0.95). Contingent employees, irrespective of gender, had a 0.77 (95% CI 0.71-0.84) times lower rate of medically certified (>3 days) sickness absence than permanent employees. Poor self-rated health status, reported diagnosed chronic diseases, and minor psychiatric morbidity were associated with medically certified absences to a less extent among contingent employees than among permanent employees. CONCLUSIONS: These findings suggest better self-rated health and a lower sickness absence rate for contingent employees than for permanent employees. The difference in sickness absence between the groups seems not only to be associated with actual differences in health, but also with different thresholds of taking sick leave or working while ill.     

Organisational justice and health of employees: prospective cohort study

Aims: To examine the association between components of organisational justice (that is, justice of decision making procedures and interpersonal treatment) and health of employees.

Methods: The Poisson regression analyses of recorded all-cause sickness absences with medical certificate and the logistic regression analyses of minor psychiatric morbidity, as assessed by the General Health Questionnaire, and poor self rated health status were based on a cohort of 416 male and 3357 female employees working during 1998–2000 in 10 hospitals in Finland.

Results: Low versus high justice of decision making procedures was associated with a 41% higher risk of sickness absence in men (rate ratio (RR) 1.4, 95% confidence interval (CI) 1.1 to 1.8), and a 12% higher risk in women (RR 1.1, 95% CI 1.0 to 1.2) after adjustment for baseline characteristics. The corresponding odds ratios (OR) for minor psychiatric morbidity were 1.6 (95% CI 1.0 to 2.6) in men and 1.4 (95% CI 1.2 to 1.7) in women, and for self rated health 1.4 in both sexes. In interpersonal treatment, low justice increased the risk of sickness absence (RR 1.3 (95% CI 1.0 to 1.6) and RR 1.2 (95% CI 1.2 to 1.3) in men and women respectively), and minor psychiatric morbidity (OR 1.2 in both sexes). These figures largely persisted after control for other risk factors (for example, job control, workload, social support, and hostility) and they were replicated in initially healthy subcohorts. No evidence was found to support the hypothesis that organisational justice would represent a consequence of health (reversed causality).

Conclusions: This is the first longitudinal study to show that the extent to which people are treated with justice in workplaces independently predicts their health.

     

Long hours in paid and domestic work and subsequent sickness absence: does control over daily working hours matter?

Objectives

To explore the associations of working hours (paid, domestic, commuting, and total) with sickness absence, and to examine whether these associations vary according to the level of employee control over daily working hours.

Methods

Prospective cohort study among 25 703 full‐time public sector employees in 10 towns in Finland. A survey of working hours and control over working hours was carried out in 2000–01. The survey responses were linked with register data on the number of self‐certified (⩽3 days) and medically certified (>3 days) sickness absences until the end of 2003. Poisson regression analyses with generalised estimating equations were used to take into account the fact that the employees were nested within work units. Adjustments were made for work and family characteristics and health behaviour. The mean follow‐up period was 28.1 (SD 8.1) months.

Results

Long domestic and total working hours were associated with higher rates of medically certified sickness absences among both genders. In contrast, long paid working hours were associated with lower rates of subsequent self‐certified sickness absences. Long commuting hours were related to increased rates of sickness absence of both types. Low control over daily working hours predicted medically certified sickness absences for both the women and men and self‐certified absences for the men. In combinations, high control over working hours reduced the adverse associations of long domestic and total working hours with medically certified absences.

Conclusions

Employee control over daily working hours may protect health and help workers successfully combine a full‐time job with the demands of domestic work.     

From insecure to secure employment: changes in work, health, health related behaviours, and sickness absence

Aims: To determine whether change in employment status (from fixed term to permanent employment) is followed by changes in work, health, health related behaviours, and sickness absence.

Methods: Prospective cohort study with four year follow up. Data from 4851 (710 male, 4141 female) hospital employees having a fixed term or permanent job contract on entry to the study were collected at baseline and follow up.

Results: At baseline, compared to permanent employees, fixed term employees reported lower levels of workload, job security, and job satisfaction. They also reported greater work ability. All fixed term employees had a lower rate of medically certified sickness absence at baseline. Baseline rate ratios for those who remained fixed term were 0.64 (95% CI 0.55 to 0.75), and were 0.50 (95% CI 0.34 to 0.75) for those who later became permanent. Continuous fixed term employment was not associated with changes in the outcome measures. Change from fixed term to permanent employment was followed by an increase in job security, enduring job satisfaction, and increased medically certified sickness absence (compared to permanent workers rate ratio 0.96 (95% CI 0.80 to 1.16)). Other indicators of work, health, and health related behaviours remained unchanged.

Conclusion: Receiving a permanent job contract after fixed term employment is associated with favourable changes in job security and job satisfaction. The corresponding increase in sickness absence might be due to a reduction in presenteeism and the wearing off of health related selection.

     

Employee control over working times: associations with subjective health and sickness absences

STUDY OBJECTIVE: To investigate the impact of employees' worktime control on health, taking into account other aspects of job control. DESIGN: Analysis of questionnaire data in 1997 and register data on sickness absence during 1996-1998. SETTING: Eight towns in Finland. PARTICIPANTS: 6442 municipal employees (1490 men and 4952 women) representing the staff of the towns studied. Follow up was 17 706 person years. MAIN RESULTS: In women, poor health and psychological distress were more prevalent among those in the lowest quartile of worktime control than those in the highest (after adjustment for potential confounders including other aspects of job control, odds ratios and their 95% confidence intervals for poor health and psychological distress were 1.8 (1.5 to 2.3) and 1.6 (1.3 to 2.0), respectively). Correspondingly, the adjusted sickness absence rate was 1.2 (1.1 to 1.2) times higher in women with low worktime control than in women with high worktime control. In men, no significant associations between worktime control and health were found. These results, obtained from the total sample, were replicable within a homogeneous occupational group comprising women and men. CONCLUSIONS: Exploration of specific aspects of job control provides new information about potentially reversible causes of health problems in a working population. Worktime control is an independent predictor of health in women but not in men. Dissimilarities in the distribution of occupations between men and women are not a probable explanation for this difference.     

Some characteristics of repeated sickness absence

Ferguson, D. (1972).Brit. J. industr. Med.,29, 420-431. Some characteristics of repeated sickness absence. Several studies have shown that frequency of absence attributed to sickness is not distributed randomly but tends to follow the negative binomial distribution, and this has been taken to support the concept of `proneness' to such absence. Thus, the distribution of sickness absence resembles that of minor injury at work demonstrated over 50 years ago. Because the investigation of proneness to absence does not appear to have been reported by others in Australia, the opportunity was taken, during a wider study of health among telegraphists in a large communications undertaking, to analyse some characteristics of repeated sickness absence.

The records of medically certified and uncertified sickness absence of all 769 telegraphists continuously employed in all State capitals over a two-and-a-half-year period were compared with those of 411 clerks and 415 mechanics and, in Sydney, 380 mail sorters and 80 of their supervisors. All telegraphists in Sydney, Melbourne, and Brisbane, and all mail sorters in Sydney, who were available and willing were later medically examined. From their absence pattern repeaters (employees who had had eight or more certified absences in two and a half years) were separated into three types based on a presumptive origin in chance, recurrent disease and symptomatic non-specific disorder.

The observed distribution of individual frequency of certified absence over the full two-and-a-half-year period of study followed that expected from the univariate negative binomial, using maximum likelihood estimators, rather than the poisson distribution, in three of the four occupational groups in Sydney. Limited correlational and bivariate analysis supported the interpretation of proneness ascribed to the univariate fit. In the two groups studied, frequency of uncertified absence could not be fitted by the negative binomial, although the numbers of such absences in individuals in successive years were relatively highly correlated.

All types of repeater were commoner in Sydney than in the other capital city offices, which differed little from each other. Repeaters were more common among those whose absence was attributed to neurosis, alimentary and upper respiratory tract disorder, and injury. Out of more than 90 health, personal, social, and industrial attributes determined at examination, only two (ethanol habit and adverse attitude to pay) showed any statistically significant association when telegraphist repeaters in Sydney were compared with employees who were rarely absent. Though repeating tended to be associated with chronic or recurrent ill health revealed at examination, one quarter of repeaters had little such ill health and one quarter of rarely absent employees had much.

It was concluded that, in the population studied, the fitting of the negative binomial to frequency of certified sickness absence could, in the circumstances of the study, reasonably be given an interpretation of proneness. In that population also repeating varies geographically and occupationally, and is poorly associated with disease and other attributes uncovered at examination, with the exception of the ethanol habit. Repeaters are more often neurotic than employees who are rarely absent but also are more often stable double jobbers.

The repeater should be identified for what help may be given him, if needed, otherwise it would seem more profitable to attack those features in work design and organization which influence motivation to come to work. Social factors which predispose to repeated absence are less amenable to modification.

     

Work factors as predictors of sickness absence: a three month prospective study of nurses' aides

Aims: To identify the work factors that predict sickness absence in nurses' aides.

Methods: The sample comprised 5563 Norwegian nurses' aides, not on leave because of illness or pregnancy when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified sickness absence (>3 days), as assessed by self reports at follow up.

Results: Perceived lack of encouraging and supportive culture in the work unit (odds ratio (OR) 1.73; 95% confidence interval (CI) 1.28 to 2.34), working in psychiatric and paediatric wards, having injured the neck in an accident, and health complaints were associated with higher risk of sickness absence, after adjustments for a series of physical, psychological, and organisational work factors, personal engagement in the work unit, demographic characteristics, and daily consumption of cigarettes. Having untraditional jobs (for nurses' aides) (OR 0.53; 95% CI 0.36 to 0.77), and engaging in aerobics or gym were associated with a lower risk of sickness absence.

Conclusions: The study suggests that the three month effects of work factors on rates of certified sickness absence are modest in nurses' aides. The most important work factor, in terms of predicting sickness absence, seems to be perceived lack of encouraging and supportive culture in the work unit.

     

Job strain and psychologic distress influence on sickness absence among Finnish employees

BACKGROUND: Work stress is a recognized risk factor for mental health disorders, but it is not known whether work stress is associated with the morbidity among individuals with psychologic distress. Another shortcoming in earlier research is related to common method bias-the use of individual perceptions of both work stress and psychologic distress. This prospective study was assessed using the General Health Questionnaire (GHQ-12), which identified psychologic distress as a predictor of sickness absence and the effect of work-unit measures of job strain on sickness absence among cases. METHODS: Survey data were collected on work stress, indicated by high job strain, for a cohort of public sector employees (6,663 women, 1,323 men), aged 18 to 62 at baseline in 2000-2002, identified as GHQ-12 cases. Coworker assessments of job strain were used to control for bias due to response style. A 2-year follow-up included recorded long-term (>7 days) medically certified sickness absence. Adjustments were made for age, socioeconomic position, baseline chronic physical disease, smoking, and heavy alcohol consumption. RESULTS: Cases with psychologic distress had 1.3 to 1.4 times higher incidence of long-term sickness absence than non cases. Among cases, high job strain predicted sickness absence (hazard ratio 1.17 in women, 1.41 in men). The significant effect of job strain on sickness absence was found among workers in high socioeconomic positions (hazard ratio 1.54 for women, 1.58 for men) but not among employees in low socioeconomic positions (hazard ratio 1.06 for women, 1.31 for men). CONCLUSIONS: Psychologic distress has an independent effect on medically certified sickness absence. The identification of employees with high job strain and the improvement of their working conditions should be considered as an important target in the prevention of adverse consequences of psychologic distress.     

Work factors and occupational class disparities in sickness absence: findings from the GAZEL cohort study

OBJECTIVES: To estimate the contribution of stress-related and physical work factors to occupational class disparities in sickness absence from work. METHODS: Our sample consisted of 8847 men and 2886 women participating in the French GAZEL cohort study. Occupational class and medically certified sickness absence data (1995-2001) were obtained from the participants' employer. Work characteristics (physical and stress-related) were self-reported. We calculated rate ratios with Poisson regression models; fractions of sickness absence attributable to work factors were estimated with the Miettinen formula. RESULTS: Sickness absence was distributed along an occupational gradient. Work characteristics accounted for 19% (women) and 21% (men) of all absences. Physical work conditions accounted for 42% and 13% of absences for musculoskeletal reasons, and work stress accounted for 48% and 40% of psychiatric absences. Overall, about 20% of the occupational class gradient in sickness absence could have been associated with deleterious work conditions. CONCLUSION: Work conditions contribute to sickness absence, particularly among manual workers and clerks. Policies that decrease ergonomic constraints and work stress also could reduce the burden of ill health and sickness absence among the lowest strata of working populations.     

A comparison of self-reported sickness absence with absences recorded in employers' registers: evidence from the Whitehall II study

Aim: To compare self-reported sickness absence days in the last 12 months with recorded absences from the employers' registers for the same period.

Methods: Self-reported sickness absence data over the 12 months preceding baseline (1985–88) were compared with absence records from the employers' registers over the same period for 2406 women and 5589 men, participants in the Whitehall II study of British civil servants. Associations with self-rated health, longstanding illness, minor psychiatric disorder, physical illness, and prevalent coronary heart disease at baseline were determined.

Results: In general, women reported less sickness absence over the last year than was recorded in the employers' registers, while men, with the exception of those in the lower employment grades, reported more. Agreement between self-reported and recorded absence days decreased as the total number of days increased. After adjustment for employment grade and the average number of recorded and self-reported absence days, the total number of self-reported absence days was within two days of the recorded number of days for 63% of women and 67% of men. Associations between annual self-reported sickness absence days and self-rated health, longstanding illness, minor psychiatric disorder, physical illness, and prevalent coronary heart disease were as strong as those for recorded absence days.

Conclusion: These findings suggest that agreement between the annual number of self-reported and the annual number of recorded sickness absence days is relatively good in both sexes and that associations with health are equivalent for both measures.

     

Work factors as predictors of sickness absence attributed to airway infections; a three month prospective study of nurses' aides

Aims: To identify the work factors that are related to sickness absence attributed to airway infections (AAI) in nurses' aides.

Methods: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified AAI (>3 days), assessed by self reports at follow up.

Results: Working in a paediatric ward (odds ratio (OR) 2.42; 95% confidence interval (CI) 1.39 to 4.21), perceived lack of encouraging and supportive culture in the work unit (OR 1.78; 95% CI 1.21 to 2.61), and reporting medium (OR 1.52; 95% CI 1.09 to 2.12), and high levels (OR 1.60; 95% CI 1.13 to 2.26) of role conflicts at work were associated with an increased risk of AAI, after adjustments for baseline health complaints, demographic and familial factors, smoking, and a series of physical, psychological, and organisational work factors. The individual level factors male gender, smoking 10 cigarettes per day or more, having widespread pain, having had an accident related neck injury, and having long term health problems also predicted AAI.

Conclusions: In nurses' aides, sickness absence attributed to airway infections seems to be related to the type of ward in which the aides are working, and to psychological and social work factors. Declaring airway infections as occupational diseases would have important consequences for the social security system.

     

Sickness absence as a predictor of mortality among male and female employees

OBJECTIVE: To determine the extent to which sickness absence is predictive of mortality. DESIGN: Prospective cohort study. Data on medically certified long term absences (>3 days), self certified short term absences (1-3 days), and sick days were derived from employers' records and data on mortality from the national mortality register. SETTING: 10 towns in Finland. PARTICIPANTS: 12821 male and 28915 female Finnish municipal employees with a job contract of five consecutive years. The mean follow up was 4.5 years. MAIN RESULTS: After adjustment for age, occupational status, and type of employment contract, the overall mortality rate was 4.3 (95% confidence intervals 2.6 to 7.0) and 3.3 (2.1 to 5.3) times greater in men and women with more than one long term absences per year than in those with no absence. The corresponding hazard ratios for more than 15 annual sick days were 4.7 (2.3 to 9.6) and 3.7 (1.5 to 9.1). Both these measures of sickness absence were also predictive of deaths from cardiovascular disease, cancer, alcohol related causes, and suicide. Associations between short term sickness absences and mortality were weaker and changed to non-significant after adjustment for long term sickness absence. CONCLUSIONS: These findings suggest that measures of sickness absence, such as long term absence spells and sick days, are strong predictors of all cause mortality and mortality due to cardiovascular disease, cancer, alcohol related causes, and suicide.     

Workplace bullying and sickness absence in hospital staff

OBJECTIVES—In the past, evidence on the negative consequences of workplace bullying has been limited to cross sectional studies of self reported bullying. In this study, these consequences were examined prospectively by focusing on sickness absence in hospital staff.
METHODS—The Poisson regression analyses of medically certified spells (4 days) and self certified spells (1-3 days) of sickness absence, relating to bullying and other predictors of health, were based on a cohort of 674 male and 4981 female hospital employees aged 19-63 years. Data on sickness absence were gathered from employers' registers. Bullying and other predictors of health were measured by a questionnaire survey.
RESULTS—302 (5%) of the employees reported being victims of bullying. They did not differ from the other employees in terms of sex, age, occupation, type of job contract, hours of work, income, smoking, alcohol consumption, or physical activity. Victims of bullying had higher body mass and prevalence of chronic disease, and their rates of medically and self certified spells of sickness absence were 1.5 (95% confidence interval (95% CI) 1.3 to 1.7) and 1.2 (1.1 to 1.4) times higher than those of the rest of the staff. The rate ratios remained significant after adjustment for demographic data, occupational background, behaviour involving risks to health, baseline health status, and sickness absence.
CONCLUSION—Workplace bullying is associated with an increase in the sickness absenteeism of the hospital staff. Targets of bullying seem not to belong to any distinct group with certain demographic characteristics or occupational background.


Keywords: workplace bullying; sickness absence; health; psychosocial factors; hospital staff     

Alcohol intake and sickness absence: a curvilinear relation

Little is known about the U-shaped relation between alcohol intake and health beyond findings related to cardiovascular disease. Medically certified sickness absence is a health indicator in which coronary heart disease is only a minor factor. To investigate the relation between alcohol intake and sickness absence, records regarding medically certified sick leaves from all causes were assessed for 4 years (1997-2000) in a cohort of 1,490 male and 4,952 female municipal employees in Finland. Hierarchical Poisson regression, adjusted for self-reported behavioral and biologic risk factors, psychosocial risk factors, and cardiovascular diseases, was used to estimate the rate ratios and their 95% confidence intervals, relating sickness absence to each level of alcohol consumption. For both men and women, a significant curvilinear trend was found between level of average weekly alcohol consumption and sickness absence. The rates of medically certified sickness absence were 1.2-fold higher (95% confidence interval: 1.1, 1.3) for never, former, and heavy drinkers compared with light drinkers. The U-shaped relation between alcohol intake and health is not likely to be explained by confounding due to psychosocial differences or inclusion of former drinkers in the nondrinkers category. Moderate alcohol consumption also may reduce health problems other than cardiovascular disease.     

Downsizing of staff is associated with lowered medically certified sick leave in female employees

Methods: The 5720 employees (aged 18–65) were from the WOLF study of cardiovascular risk factors in working men and women in greater Stockholm during the years 1992–95. From the medical examination a cardiovascular score was calculated for each participant. The WOLF study base was linked to a Statistics Sweden registry of economic and administrative activities. Sick leave spells lasting for at least 15 days during the calendar year following downsizing/expansion were identified for each subject.

Results: In multiple logistic regression an increased likelihood of having no medically certified sick leave (15 days or more) was found in women during the year following both downsizing and expansion. These analyses were adjusted for age and cardiovascular score. A high cardiovascular risk score reduced the likelihood of having no medically certified sick leave. The inclusion of psychosocial work environment variables did not change the results markedly. Separate analyses of women with and without high cardiovascular score showed that downsizing had a more pronounced effect on reduced long term sick leave among those with high than among those without low cardiovascular score. There were no consistent findings in men.

Conclusions: There is evidence of a reduction of long term sick leave in women after downsizing and this is particularly evident among those with high cardiovascular score.

     

The association between sex segregation, working conditions, and sickness absence among employed women

Methods: The study group consisted of 1075 women employed as nurses, assistant nurses, medical secretaries, or metal workers who answered a questionnaire comprising 218 questions on women's health and living conditions. Sickness absence was collected from employers' and social insurance registers.

Results: Women working in the male dominated occupation had in general higher sickness absence compared to those working in female dominated occupations. However, metal workers at female dominated work sites had 2.98 (95% CI 2.17 to 3.79) sick-leave spells per woman and year compared to 1.70 (95% CI 1.29 to 2.10) among those working with almost only men. In spite of a better physical work environment, female metal workers at a female dominated work site had a higher sickness absence than other women, which probably could be explained by the worse psychosocial work environment. Working with more women also had a positive association to increased frequency of sick-leave spells in a multivariate analysis including several known indicators of increased sick-leave.

Conclusions: There was an association between sickness absence and sex segregation, in different directions at the occupational and work site level. The mechanism behind this needs to be more closely understood regarding selection in and out of an occupation and a certain work site.

     

Local economy and sickness absence: prospective cohort study

STUDY OBJECTIVE: To investigate the effect of the local economy, as measured by municipal revenue and local unemployment rate, on sickness absence among the employed. DESIGN: A prospective cohort study of 60 160 public sector employees (46 081 women, 14 079 men) with ecological measures of municipal revenue and local unemployment rate 1999-2000 and individual measures of sickness absence at baseline 1999 and at follow up 2000-2001. RESULTS: Among men and women, constantly poor local economy, as shown by low municipal revenue and high unemployment rate, was related to decreased self certified sickness absence rates. Local unemployment rate was a stronger predictor of self certified sickness absence than municipal revenue and the effect was stronger among men than among women. High unemployment rate predicted increased medically certified sickness absence among women. CONCLUSIONS: Working in areas of poor local economy is associated with increased long term sickness absence but decreased probability to take a short term sick leave. Unemployment rate may have an effect on the threshold to take a sick leave in relation to minor illnesses even when area deprivation poses health risk to its residents. To prevent adverse health effects of presenteeism, working while ill, and to reduce medically certified sickness absence, potential benefits may be attained by improving economic conditions and re-employment in deprived areas.     

Changes in leisure-time physical activity and subsequent sickness absence: A prospective cohort study among middle-aged employees

ObjectiveThe aim of this study was to examine how changes over time in leisure-time physical activity are associated with subsequent sickness absence.MethodsHelsinki Health Study cohort baseline questionnaire survey data were collected in 2000–2002 among 40–60-year-old employees of the City of Helsinki, Finland. A follow-up survey was conducted in 2007. 4182 (83% women) respondents were available for the analyses. Leisure-time physical activity was asked using identical questions in both surveys. Sickness absence data were derived from the employer's registers (mean follow-up time 2.8 years). Associations of changes over time in leisure-time physical activity with self-certified (≤ 3 days) and medically certified (> 3 days) sickness absence spells were examined, using Poisson regression analysis.ResultsInactive women and men who increased their physical activity to vigorously active had a significantly lower risk of both self-certified (RR = 0.80, 95% CI 0.65–0.97) and medically certified (RR = 0.63, 95% CI 0.49–0.83) subsequent sickness absence spells compared with the persistently inactive. The persistently active with vigorous intensity had the lowest risk of sickness absence. Adjusting for changes in physical health functioning attenuated but did not abolish the lowered risk found.ConclusionsFor reducing sickness absence more emphasis should be given to the potential contribution of vigorous physical activity.     

Occupational categories and sickness absence certified as attributable to common diseases

BACKGOUND: This paper focuses on the relationship between sickness absence rates certified as attributable to common (non-work-related) diseases and occupational categories. METHODS: A cohort of 2,909 workers from an urban bus company was analysed from 1994 to 1996 (8,388.7 person-years), who reported 2,893 non-work-related sickness absence spells of three days or more (78% of all sickness absence spells in the period). Rates of sickness absence were calculated and an extension of the Andersen-Gill approach to proportional hazards modelling was used to adjust covariables. RESULTS: Assistant staff (35.63 per 100 person-years), and bus drivers (37.23) had the highest incidence rates. After adjusting for demographic variables, employment duration and health status, it was found that all occupational categories had a significant rate ratio (RR) in comparison to the manager category. The strongest positive associations were found among bus drivers (RR = 2.45; 95% CI: 1.52-3.97), assistant staff (RR = 2.57; 1.67-3.94), and technical staff (RR = 2.42; 1.57-3.74). CONCLUSION: Occupational category was an important predictor of sickness absence incidence certified as attributable to common disease. Further research on the associations between working conditions and sickness absence needs to take into account the distinction between sickness absences due to work-related diseases and those due to common diseases.