Recurrence of Medically Certified Sickness Absence According to Diagnosis: A Sickness Absence Register Study

Introduction Sickness absence is a major public health problem. Research on sickness absence focuses on interventions aimed at expediting return to work. However, we need to know more about sustaining employees at work after return to work. Therefore, this study investigated the recurrence of sickness absence according to diagnosis. Methods We analyzed the registered sickness absence data of 137,172 employees working for the Dutch Post and Telecom. Episodes of sickness absence were medically certified, according to the ICD-10 classification of diseases, by an occupational physician. The incidence density (ID) and recurrence density (RD) of medically certified absences were calculated per 1,000 person-years in each ICD-10 category. Results Sickness absence due to musculoskeletal disorders had the highest recurrence (RD = 118.7 per 1,000 person-years), followed by recurrence of sickness absence due to mental disorders (RD = 80.4 per 1,000 person-years). The median time to recurrent sickness absence due to musculoskeletal disorders was 409 days after the index episode. Recurrences of sickness absence due to musculoskeletal disorders accounted for 37% of the total number of recurrent sickness absence days. For recurrences of sickness absence due to mental disorders this was 328 days and 21%, respectively. Unskilled employees with a short duration (<5 years) of employment had a higher risk of recurrent sickness absence. Conclusions Interventions to expedite return to work of employees sick-listed due to musculoskeletal or mental disorders should also aim at reducing recurrence of sickness absence in order to sustain employees at work.     

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     

Trends in socioeconomic differences in sickness absence among Finnish municipal employees 1990-99

AIMS: This study examined the associations of key dimensions of socioeconomic status and long sickness absence spells as well as their changes over time from 1990 to 1999. METHODS: Municipal employees of the City of Helsinki, Finland, aged 25-59 were studied. The number of participants varied yearly from 24,029 women and 6,523 men to 27,861 women and 7,521 men. Socioeconomic status was assessed by education, occupational class, and individual income. The outcome was the number of over three days' sickness absence spells/100 person years, for which the employer requires medical certification. RESULTS: Low education, occupational class, and individual income were consistently associated with a 2-3 times higher sickness absence rates among both men and women. The age-adjusted sickness absence rates were relatively stable from 1990 to 1994 but increased from 1994 to 1999 among men and women. Socioeconomic differences in sickness absence rates tended to increase. CONCLUSIONS: The increase in the level of socioeconomic differences in sickness absence took place during a period of declining unemployment and staff increases at the City of Helsinki, which indicates that labour market conditions play a role in sickness absence.     

Sickness Absence in Drivers of London Taxis and Buses

Sickness absence data for periods of 1 week or more among 2385London taxi drivers were analysed over a period of 1 year. Thereasons, in order of decreasing prevalence, were accidents,disorders of bone and movement, circulatory disorders, and respiratorydisorders. In order to place the absence rates of taxi driversin perspective, a comparison over the same year was made withsimilar sickness absence data for the total work force (12 639)of bus drivers for London Transport. It was found that the busdrivers incurred about 3 times as many days of sickness absence(22.1 days per person compared with 65 days for taxi drivers)and 4 times as many spells of absence (0.73 spells per personcompared with 0.16 spells for taxi drivers) as compared withtaxi drivers. The main reason for these differences was consideredto be due to the terms of employment including sick pay arrangementsof the two groups. Accepted        1 August 1981 Requests for reprints should be addressed to: Dr A. R. Erlam, Medical Centre, 201 Hamilton Road, Felixstowe, Suffolk, IP2 7DT.     

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.     

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   

Relations between respiratory symptoms and sickness among workers in the animal feed industry.

OBJECTIVE--The survey aimed at studying the associations between prevalent respiratory symptoms in an occupational population and sickness absence due to respiratory disorders. METHODS--A cross sectional survey among male workers in an animal feed mill was conducted. A total of 303 production workers and 102 office clerks completed a questionnaire on respiratory complaints, smoking habits, and occupational history. The questionnaire was used to identify workers with respiratory symptoms in the past 12 months. During this period all spells of sickness absence were recorded. Causes of sickness were classified in broad categories encompassing respiratory symptoms, influenza, musculoskeletal disorders, and others. RESULTS--Logistic regression analysis showed that workers with respiratory complaints experienced a higher sickness absence than those without respiratory complaints. Adjusted for age and smoking the odds ratio (OR) for sickness prevalence was 1.9 among office clerks and 2.6 among blue collar workers. Smoking increased the risk on sickness absence with ORs of 2.4 and 1.6, respectively. When restricting the analysis to sickness due to respiratory complaints, subjects with respiratory complaints had significantly higher risks for absence prevalence and absence rate than those without respiratory complaints. There were no differences in sickness absence between workers with asthma like complaints and those with chronic bronchitis like complaints. CONCLUSION--The clear associations between respiratory complaints and prevalence and rate of respiratory sickness absence indicate that workers with respiratory complaints are at risk of temporary disability and, thus, may experience a reduced ability to cope with routine activities at work.     

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.     

Occupational and regional associations of death, disablement, and sickness absence among Post Office staff 1972-75.

Rates of death in service and rates of premature retirement due to disability in an employed population of more than 400 000 people under the age of 60 years have been compared with duration rates of certified sickness absence for three years from April 1972. Standardized for age, rates of sickness absence and of death, combined with retirement (medical wastage) for men and women differed between 11 occupational groups by a factor of three. Significant rank correlations were observed between these two measures of ill health, rs = 0-827 for men, rs = 0-857 for women. Similar comparisons for 1974/75 of rates for staff employed in 10 geographical regions of the United Kingdom standardized for age and occupation, revealed twofold differences of rate, and rank correlation coefficients of + 0-794 for men and + 0-649 for women. These observations show that the duration of certified sickness absence is higher in groups of people showing other objective evidence of ill health and who are most in need of preventive health care. The need is discussed for a balanced view of the complex aetiology of sickness absence.     

Analysis of sickness absence among employees of four NHS trusts

OBJECTIVES: To determine the value of using routinely collected sickness absence data as part of a health needs assessment of healthcare workers. METHOD: Sickness absence records of almost 12900 NHS staff for one calendar year were analysed. Three measures of absence, the absence rate, the absence frequency rate, and the mean duration of absence, were assessed for the population and comparisons made between men and women, full and part time and different occupational groups of staff. Also, the main causes of sickness absence were found. RESULTS: Almost 60% of the study population had no spells of sickness absence in the year of study and almost 20% had only one spell of sickness absence. Female staff were more likely to have experienced sickness absence than male staff. Although absence due to conditions related to pregnancy were included in the analysis, the incidence of these was not sufficient to account for the higher rates of absence among female staff. In general, full time staff had greater rates of sickness absence than part time staff. 71% of all absences were of < 1 week duration. The main known causes of sickness absence were respiratory disorders, digestive disorders, and musculoskeletal disorders. CONCLUSIONS: The transition from units managed directly from the health board to trusts with individual responsibility for personnel issues at the time of data collection resulted in variations in the quality of data available for analysis. This together with the use of "dump" codes has influenced the quality of the analysis. However, such data should be available for analysis to tailor occupational health care to the needs of the population.

 

     

The influence of GP and patient gender interaction on the duration of certified sickness absence

BACKGROUND: Little research has focused upon how GP and patient gender interact to influence the outcome of consultation. In particular, no UK studies have investigated the effect of gender interaction on the duration of patients' certified sickness. OBJECTIVE: To investigate associations between the four GP-patient gender interaction categories and patient risk of intermediate or long-term work incapacity. METHODS: Design: Use of carbonized sickness certificates to collect routine sick note data over a 12-month collection period. Setting: Nine general practices in the Mersey Primary Care R&D Consortium. Subjects: A total of 3906 patients, certified sick by 67 GPs (including 45 GP principals). Main outcome measures: The effect of gender interaction was measured against two outcomes: intermediate (6-28 week) and long-term (28 weeks or over) periods of certified sickness. RESULTS: After univariate and multivariate analyses, it was discovered that certification of male patients by male GPs was significantly associated with increased prevalence of intermediate (6-28 week) certified sickness outcomes, compared with females certified by females (OR=1.38 P=0.009). This result was replicated in the subgroup of patients with mild mental disorder-related sickness absence. However, no association was demonstrated between gender interaction and long-term (>or=28 week) outcome, in the total patient group or within diagnostic subcategories. CONCLUSION: GP and patient gender appear to have most impact upon sickness certification in the intermediate period. This period is already recognized as the optimum time for interventions to prevent onset of long-term incapacity, particularly in cases where the cause of sickness absence is reversible (as in psychological-related certified sickness absence). Further research is needed (particularly focusing upon attitudes and content of consultations) in order to shed more light on the gender differences found in this study.     

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.     

Occupational exposure to carcinogens and risk of lung cancer: results from The Netherlands cohort study.

OBJECTIVES: To investigate risk of lung cancers associated with common established carcinogenic occupational exposures (asbestos, paint dust, polycyclic aromatic hydrocarbons, and welding fumes) in a prospective cohort study among the general population, and to estimate the proportion of lung cancer cases attributable to these occupational exposures. METHODS: A prospective cohort study on diet, other lifestyle factors, job history, and cancer risk that started in 1986 in The Netherlands on 58,279 men, aged 55-69 years. Based on information about job history obtained from a self-administered questionnaire, case by case expert assessment was carried out to assign to each study subject a cumulative probability of occupational exposure for each carcinogenic exposure. For analysis, a case-cohort approach was used, in which the person-years at risk were estimated from a randomly selected subcohort (n = 1688). After 4.3 years of follow up, 524 lung cancer cases with complete job history were available. RESULTS: After adjustment for age, each of the other occupational exposures, and for smoking habits and intake of vitamin C, beta-carotene, and retinol, significant associations were found between risk of lung cancer and cumulative probability of occupational exposure to asbestos (relative risk (RR) highest/no exposure = 3.49, 95% confidence interval (95% CI) 1.69 to 7.18, trend P < 0.01 or paint dust (RR highest/no exposure = 2.48, 95% CI 0.88 to 6.97, trend P < 0.01). The population attributable risks (PARs) for the four exposures based on the multivariately adjusted RRs for ever exposed versus never exposed workers were calculated. The PAR of lifetime occupational exposure to asbestos was calculated to be 11.6%. CONCLUSIONS: This prospective cohort study among the general population showed that occupational exposure to asbestos or paint dust is associated with higher RRs for lung cancer. This study shows that after adjustment for smoking and diet about 11.6% of the cases of lung cancer in men is attributable to lifetime occupational exposure to asbestos.     

Sickness absence in female- and male-dominated occupations and workplaces

Previous research suggests that both men's and women's level of sickness absence may be systematically related to the gender composition of their workplace as well as of their occupational category. The number of studies is, however, low and the composition of the occupational category has often been used as a proxy for the composition of the workplace. This paper employs a large data set broadly representative of the employed population of Norway. The data make it possible to take workplace and occupation simultaneously into account. Thus, the relationship between the gender composition of the workplace and sickness absence is estimated with detailed control for differences between occupational categories. Likewise, the importance of the gender composition of the occupation is assessed with control for between workplace variation. Men's sickness absence turns out to be largely unrelated to the gender composition of the workplace. For women the level of sickness absence tends to be higher in female-dominated workplaces, but the relationship is weak. These findings provide evidence against theories suggesting that the minority sex in the workplace faces special problems and is therefore more absent. They are to some extent consistent with the idea that female-dominated workplaces develop norms that are more tolerant towards sickness absence. The relationship of sickness absence to the gender composition of the occupational category is similar to the U-shaped pattern found in several previous studies (highest sickness absence both in strongly male-dominated and strongly female-dominated occupations), but again the relationship is weak.     

Job characteristics,physical and psychological symptoms,and social support as antecedents of sickness absence among men and women in the private industrial sector

Most longitudinal studies on the relationship between psychosocial health resources and risks, and the employees' subsequent sickness absences have been conducted in the public sector. The purpose of this study was to find out psychosocial antecedents of sickness absenteeism in the private industrial sector. The effects of job characteristics (job autonomy and job complexity), physical and psychological symptoms, and social support (from coworkers and supervisors) on sickness absenteeism were investigated. The number of long (4-21 days) and very long (>21 days) sickness absence episodes of 3895 persons (76% men and 24% women, mean age 44 years) was obtained from the health registers of a multinational forest industry corporation in 1995-1998. A questionnaire survey on the working conditions and health of the workers was carried out in 1996. The follow-up time of the sickness absences was 1-year 9-month. Job autonomy was found to be associated with long and very long episodes in men (rate ratio (RR) in the lowest autonomy group approximately 2 times higher than the highest autonomy group), and with very long episodes of absence in women (2-3 times higher RR between the low vs. the high category). Low job complexity predicted men's very long absences (RR 1.4). Long and very long episodes were associated with physical and psychological symptoms (RR 1.2-1.7) among men and women. Lack of coworkers' support increased the frequency of very long sickness absence among men (RR 1.4), and lack of supervisor's support among women (RR 1.6). Also, some interaction effects of social support variables were observed among both genders. We conclude that the studied psychosocial factors are associated with subsequent sickness absence, and that the associations are partly gender-specific. The results showing which variables are related to employees' sickness absenteeism in the private industrial sector can be applied in human resource management and health service planning.     

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.     

广州市不同工业行业职工主要死因分析

目的　比较广州市不同工业行业职工的主要死因。方法　将广州市工业系统参照中国卫生监督统计报告表行业分类分为 6个行业 ,以 1989～ 1992年实施职业健康监护系统中建立的 795 4 7名年龄≥ 35岁的工厂职工个体健康档案为基础资料 ,按前瞻性队列研究方法 ,随访至 1998年 12月 31日 ,登记队列中职工的生存状态和死亡原因 ,计算粗死亡率 ,用Cox比例风险模型计算RR及 95 %CI。结果　 (1) 795 4 7名职工中 ,男 4 935 5人、女 30 192人 ,平均年龄 (43.8± 6 .5 )岁 ,6 4 %的职工年龄在 35～4 4岁 ,各行业职工年龄相近 ,相差± 1岁 ;4 1%的职工接触职业有害因素 ,石化行业职业有害因素接触率最高 (5 3.9% ) ,冶金行业次之 ,机械行业最低 (30 .2 % )。 (2 )截至 1998年 12月 31日 ,平均追踪 (8.0±1.3)年 ,共 6 335 10人年 ;共有 15 77名职工死亡 ,总死亡率为 2 4 8.9/ 10万人年 ,其中橡胶行业总死亡率最高 ,其次为冶金和石化行业 ,主要死因为恶性肿瘤、血管疾病和呼吸系统疾病 ,占总死亡人数的 80 .3%。(3)全死因和血管疾病的粗死亡率橡胶行业排第一位 ,恶性肿瘤和呼吸系统疾病粗死亡率则为冶金行业排第一位。 (4)调整各相关因素后 ,以轻工行业为对照 (RR为 1.0 ) ,发现冶金行业的恶性肿瘤和呼吸系统疾病的RR(     

The connection between age,job control and sickness absences among Finnish food workers

METHODS: The relationship between sickness absence and job control among industrial food workers of different ages (n = 114) was studied. RESULTS: The number of absence spells, particularly short absence spells, was higher among younger workers, as expected. Using multivariate analysis, low job control was associated with an increased number of all absence spells (P < 0.02). CONCLUSIONS: Job control may be an important factor in determining sickness absence among industrial workers.     

Sickness absence at the French National Electric and Gas Company.

The certified sickness absence of workers in the French National Electric and Gas Company was studied for 12 months and has been described according to the demographic and occupational characteristics of the employees. The results showed that the principal factors affecting absence are sex, job, and salary. The high percentage of absent women was explained by neither the type of occupation nor family status. Respiratory diseases, accidents, and musculoskeletal and psychiatric disorders were the leading diagnostic categories. Indices of severity, duration, and frequency were calculated and compared between groups. The duration of absence increased with the severity of the medical cause of absence and with the patient's age.     

Lung and bladder cancer among Danish urban bus drivers and tramway employees: a nested case-control study

BACKGROUND: The combustion of fossil fuels produces small amounts of mutagenic and carcinogenic compounds. We investigated the association between employment and lung and bladder cancer in Danish bus drivers and tramway employees. METHODS: We carried out a nested case-control study of 153 lung and 84 bladder cancer cases, and 606 controls sampled in a cohort of 18 174 bus drivers or tramway employees employed in Copenhagen during the period 1900-1994. The cases and controls or their next of kin were interviewed about smoking, along with occupational and residential history. An exposure index based on which bus routes the bus drivers had mainly been driving was established. Relative risks (RRs) were estimated by conditional logistic regression. RESULTS: The analysis showed decreasing risk for lung cancer with increasing years of employment as a bus driver (RR = 0.97 for each added year, 95% confidence interval = 0.96-0.99). The air pollution index based on main bus for the bus drivers showed no positive correlation with risk.