Abstract
While studies have found a social gradient in negative consequences of drinking and smoking, evidence is less clear for a gradient also in alcohol use and smoking's association with sickness absence. We investigate the association between alcohol use and cigarette smoking and general sickness absence, and examine the moderating role of socio-economic status for these associations when controlling for general health status. Questions on alcohol use, measured by the Alcohol Use Disorders Identification Test (AUDIT-C), smoking, general health and sickness absence were included in annual national cross-sectional telephone surveys on alcohol, tobacco and drug use (2015-18) amongst Norwegian adults aged 16-79-years (average response rate=59%). The analytic sample comprised 4719 full- and part-time employees aged 25-79 years (46.7% were female, mean age=44.3 years). Individual-level data on education were obtained from national registries. In adjusted negative binomial regression analyses, current and former daily smoking were associated with a higher occurrence of sickness absence in groups with low educational attainment, but not in groups with high educational attainment. Alcohol use was negatively associated with sickness absence. While a significantly higher number of sickness days was reported by smokers in the low compared with the high education group, educational attainment did not moderate the alcohol use - sickness absence association. Daily smoking is associated with sickness absence. A negative social gradient was found in the smoking - absence association. Reduced daily smoking might give a reduction in sickness absence.
Highlights
While studies have found a social gradient in negative consequences of drinking and smoking, evidence is less clear for a gradient in alcohol use and smoking’s association with sickness absence
The average number of sickness absence days reported by non-drinkers were almost twice as high as the average number of sickness days reported by heavy drinkers, with moderate drinkers falling in between
Due to over-dispersion, Poisson regression was not suitable, and a negative binomial model was used to regress smoking and alcohol use on past year sickness absence days, controlling for gender, age, educational attainment and general health
Summary
While studies have found a social gradient in negative consequences of drinking and smoking, evidence is less clear for a gradient in alcohol use and smoking’s association with sickness absence. Sickness benefits contribute to reduce such social inequality in health (Bambra et al, 2010), and are important elements of the welfare state model. They are costly to maintain, and states generally wish to keep them at low levels. Despite a political goal to achieve a reduction, Norwegian sickness absence levels have remained stable at around 6% for several years (Statistics Norway, 2020). This is a higher prevalence than in other European countries (Barmby, Ercolani, & Treble, 2002), and with an annual spending of 2–3% of gross domestic product (GDP), Norwegian sickness and disability benefits are higher than in the other Nordic countries (IMF, 2019)
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