Self-reported work ability predicts health-related exit and absence from work, work participation, and death: longitudinal findings from a sample of German employees

Matthias Bethge,Katja Spanier,Anna Schlumbohm,Stefanie Köhn

doi:10.1007/s00420-020-01608-4

Abstract

ObjectiveThe cohort study examined the performance of the Work Ability Index in predicting health-related exit and absence from work, work participation, and death among a sample of workers previously receiving sickness absence benefits.MethodsWorkers aged 40–54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records covering the period until the end of 2016.ResultsData for 2266 participants were included (mean age: 47.9 years; 54.4% women). Maximum follow-up was 43 months. In terms of work ability, 38.4% had good scores, 38.2% moderate scores, and 23.4% poor scores. Fully adjusted analyses showed an increased risk of a disability pension in workers with poor (HR = 12.98; 95% CI 5.81–28.99) and moderate Work Ability Index scores (HR = 3.17; 95% CI 1.36–7.38) compared to workers with good or excellent scores. The risk of a rehabilitation measure was also significantly increased for workers with poor and moderate scores. In addition, poor scores were prospectively associated with a longer duration of sickness absence and unemployment benefits, and fewer employment days and less income from regular employment. Those with poor Work Ability Index scores also had a significantly increased risk of premature death.ConclusionsThe Work Ability Index is a potential tool to identify individuals with previous long-term sickness absence having an increased risk of health-related exit and absence from work and poor work participation outcomes.

Highlights

The prevention of work disability and maintenance of work ability may require different actions, ranging from simple workplace adjustments to multi-component programmes
In a previous paper using the baseline data of our study, we showed that self-reported work ability measured by the Work Ability Index (WAI) was associated with a higher prevalence of occupational and behavioural health risks (Bethge et al 2015)
We reported that the WAI predicted disability pensions, use of rehabilitation services, sickness absence, and unemployment benefits, as well as income from and days in regular employment after a follow-up of roughly one and a half years (Bethge et al 2018)

Summary

Introduction

The prevention of work disability and maintenance of work ability may require different actions, ranging from simple workplace adjustments to multi-component programmes. In cases with complex needs, coordinated care is essential to harmonise endeavours and services. This usually requires additional financial and staff resources. Risk-adjusted and stepped-care models are approaches that may achieve both efficient use of resources and access to coordinated care by establishing treatments of different levels of intensity. This model is well known from psychiatric care (Heddaeus et al 2019) and has already been applied in occupational medicine and disability management (Aust et al 2015; Poulsen et al 2014; van Holland et al 2012). If the patient does not respond to treatment, care will continue at the level of intensity

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