Associations between number of sick-leave days and future all-cause and cause-specific mortality: a population-based cohort study.

Emma Björkenstam,Gunilla Ringbäck Weitoft,Kristina Alexanderson,Ellenor Mittendorfer-Rutz,Christina Lindholm,Charlotte Björkenstam

doi:10.1186/1471-2458-14-733

Emma Björkenstam, Gunilla Ringbäck Weitoft + Show 4 more

Open Access

https://doi.org/10.1186/1471-2458-14-733

Copy DOI

Abstract

BackgroundAs the number of studies on the future situation of sickness absentees still is very limited, we aimed to investigate the association between number of sick-leave days and future all-cause and cause-specific mortality among women and men.MethodsA cohort of 2 275 987 women and 2 393 248 men, aged 20–64 years in 1995 was followed 1996–2006 with regard to mortality. Data were obtained from linked authority-administered registers. The relative risks (RR) and 95% confidence intervals (CI) of mortality with and without a 2-year wash-out period were estimated by multivariate Poisson regression analyses. All analyses were stratified by sex, adjusting for socio demographics and inpatient care.ResultsA gradually higher all-cause mortality risk occurred with increasing number of sick-leave days in 1995, among both women (RR 1.11; CI 1.07-1.15 for those with 1–15 sick-leave days to RR 2.45; CI 2.36-2.53 among those with 166–365 days) and men (RR 1.20; CI 1.17-1.24 to RR 1.91; CI 1.85-1.97). Multivariate risk estimates were comparable for the different causes of death (circulatory disease, cancer, and suicide). The two-year washout period had only a minor effect on the risk estimates.ConclusionEven a low number of sick-leave days was associated with a higher risk for premature death in the following 11 years, also when adjusting for morbidity. This was the case for both women and men and also for cause-specific mortality. More knowledge is warranted on the mechanisms leading to higher mortality risks among sickness absentees, as sickness certification is a common measure in health care, and most sick leave is due to diagnoses you do not die from.

Highlights

As the number of studies on the future situation of sickness absentees still is very limited, we aimed to investigate the association between number of sick-leave days and future all-cause and cause-specific mortality among women and men
To sickness certify patients is a common measure in healthcare, why more knowledge is warranted on associations between sickness absence and premature death
The aim of this study was to investigate the associations between number of sick-leave days and future allcause and cause-specific mortality among women and men, adjusting for morbidity and socioeconomic status, and taking into account a two-year wash-out period for the relative risk of mortality

Summary

Introduction

As the number of studies on the future situation of sickness absentees still is very limited, we aimed to investigate the association between number of sick-leave days and future all-cause and cause-specific mortality among women and men. The number of studies on risk factors for sickness absence has increased much, the number of studies on the future situation of sickness absentees is still very limited [1]. To account for that when trying to disentangle the associations between sickness absence and morbidity, sometimes a so called wash-out period is introduced, to exclude all deaths occurring in a near time frame, e.g., using a twoyear wash out period [5]

Objectives

Methods

Results

Conclusion