Predictors Of Sickness Absence Research Articles

Determinants of sickness absence in police: Case study of Abu Dhabi police department, UAE

Sickness absence among employees is reported to reduce organization profits and performance and thus threaten the organization's existence in the market. The monitoring and reporting of data on sickness absence is considered a crucial element of reactive health and safety control systems in organizations. It is one of the major indicators of organizational continuous commitment to improving the quality of working conditions. However, sickness absence in Police in the United Arab Emirates (UAE) is less investigated. The Occupational Health and Safety Survey developed for this study was distributed to 1317 employees of the Capital Police Directorate of Abu Dhabi Police. The survey was answered by 760 employees (58 %). While 230 (17 %) refused to participate, 259 (20 %) did not return the surveys, and 68 (5 %) were not surveyed as they were on authorized long-term leave for various reasons (and did not receive the survey). This study analyzes if the psychosocial work factors, physical work exposure factors, and employee's perception of the health and safety management system predict sickness absence in the Abu Dhabi Police after taking into account the other covariates. This study found no association between job control and the risk of sickness absence, in contrast to findings from other studies. There was also no association between psychological job demand and the perception of health and safety management with the risk of sickness absence in this study. Officers who fit the ‘job strain’ category did not have a significant increase in the risk of sickness absence in this study. However, high levels of combined physical exposures reported a significant relation with sickness absence. In conclusion, this, being one of the first studies in the region, provides insights on work factors and perception of HSE on sickness absence and provides recommendations within the context of the region for future studies and address sickness absence among police in the UAE.

Commuting and sick leave: a retrospective longitudinal study among a Belgian military population

ObjectivesIn a military context, people often have to deal with long commuting distance. The aim of the current study is to investigate to what extent commuting distances predict sickness absence...

Prospective associations of psychosocial work factors with sickness absence spells and duration: Results from the French national working conditions survey.

Some psychosocial work factors are associated with sickness absence, however little information is available on the associations of various psychosocial work factors and multiple exposures with sickness absence spells and duration, and gender differences. Data were from the French working conditions survey conducted on a nationally representative sample of the working population. The study sample included 17,437 employees (7292 men, 10,145 women) followed from 2013 to 2016 and/or from 2016 to 2019. Occupational exposures (20 psychosocial work factors, 4 working time/hours factors, 4 physical work exposures) were measured at the beginning of each follow-up period. Hurdle and multinomial models were used to study the associations with the number of days and spells of sickness absence. Most of the psychosocial work factors predicted the risk of at least 1 day of sickness absence. Stronger associations were found among women than men for some factors. Psychosocial work factors were more likely to predict the number of spells than the number of days of sickness absence. Some physical work exposures predicted sickness absence spells and days, whereas shift work in women predicted the risk of at least 1 day of sickness absence. Dose-response associations were found between multiple psychosocial work exposures and sickness absence spells, and between multiple physical exposures and sickness absence spells and days. Comprehensive prevention policies oriented toward the whole psychosocial and physical work environment should be useful to reduce sickness absence among men and women.

Psychosocial and organisational work factors as predictors of sickness absence among professionally active adults with common mental disorders

BackgroundThe incidence of sickness absence (SA) due to common mental disorders (CMDs) has increased in recent decades. It is hence important to elucidate how individuals with CMDs can maintain work. The aim was to analyse the relationship between psychosocial and organisational workplace factors and a spell of > 14 days of SA among persons with CMDs.MethodsIncluded were respondents of the Swedish Work Environment Survey (SWES) 1993–2013, diagnosed with a CMD up to five years before the interview in the SWES (n = 3,795). Relative Risk (RR) regression models with 95% Confidence Intervals (CIs) analysed associations between psychosocial-, and organisational workplace factors and a subsequent spell of SA > 14 days.ResultsLow control over work (RR:1.16; CI:1.01–1.35), job strain (RR:1.25; CI:1.04–1.49), no flexible working hours (RR:1.25; CI:1.08–1.45) or no possibility to work from home (RR:1.37; CI:1.13–1.66) were significantly related to an increased risk of SA. Persons diagnosed with depression experiencing job strain had the highest increased risk of SA (RR:1.55; CI: 1.07–2.25).ConclusionsA sustainable work-life among working individuals with CMDs can be provided by reducing job strain, and if possible, by increasing flexibility regarding workplace and working hours. This may prevent spells of SA, and hereby increase productivity.

Predictors and consequences of moral distress in home-care nursing: A cross-sectional survey.

Nurses frequently face situations in their daily practice that are ethically difficult to handle and can lead to moral distress. This study aimed to explore the phenomenon of moral distress and describe its work-related predictors and individual consequences for home-care nurses in Germany. A cross-sectional design was employed. The moral distress scale and the COPSOQ III-questionnaire were used within the framework of an online survey conducted among home-care nurses in Germany. Frequency analyses, multiple linear and logistic regressions, and Rasch analyses were performed. The invitation to participate was sent to every German home-care service (n = 16,608). The study was approved by the Data Protection Office and Ethics Committee of the German Federal Institute for Occupational Safety and Health. A total of 976 home-care nurses participated in this study. Job characteristics, such as high emotional demands, frequent work-life-conflicts, low influence at work, and low social support, were associated with higher disturbance caused by moral distress in home-care nurses. Organizational characteristics of home-care services, such as time margin with patients, predicted moral distress. High disturbance levels due to moral distress predicted higher burnout, worse state of health, and the intention to leave the job and the profession, but did not predict sickness absence. To prevent home-care nurses from experiencing severe consequences of moral distress, adequate interventions should be developed. Home-care services ought to consider family friendly shifts, provide social support, such as opportunities for exchange within the team, and facilitate coping with emotional demands. Sufficient time for patient care must be scheduled and short-term takeover of unknown tours should be prevented. There is a need to develop and evaluate additional interventions aimed at reducing moral distress, specifically in the home-care nursing sector.

Economics of mental wellbeing: A prospective study estimating associated productivity costs due to sickness absence from the workplace in Denmark

BackgroundFew studies have assessed associations between mental wellbeing (MWB) and productivity loss using nationally-representative longitudinal data. The objective of the study was to determine how different levels of MWB are associated with future productivity loss or costs due to sickness absence. MethodsData stem from a Danish nationally representative panel study of 1,959 employed adults (aged 16–64 years old) conducted in 2019 and 2020, which was linked to Danish register data. The validated Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) was used to assess MWB in 2019. The outcome was days absent from work due to sickness in 2020. Linear regression models were used to predict sickness absence in 2020 while adjusting for sickness absence in 2019, sociodemographics and health status, including psychiatric morbidity. Productivity loss or costs were estimated using the human capital approach (HCA) and friction cost approach (FCA). Costs are expressed in USD PPP. ResultsEach point increase in MWB was significantly associated with fewer sick days in 2020 and, by extension, lower productivity loss (reported in the order HCA/FCA). As compared to low MWB, moderate MWB was associated with $-1,614/$-1,271 per person in 2020, while high MWB was associated with $-2,351/$-1,779 per person in 2020. Extrapolated to the Danish population (2.7 M employed adults aged 16–64) and as compared to low MWB (12.3% of the population), moderate MWB (67.3% of the population) was associated with lower productivity loss amounting to $-2.9bn/$-2.3bn in 2020, while high MWB (20.4% of the population) was associated with lower productivity loss amounting to $-1.3bn/$-0.9bn in 2020. ConclusionsHigher levels of MWB are associated with considerably less productivity loss. Substantial reductions in productivity loss could potentially be achieved by promoting higher levels of MWB in the population workforce.

Use of sickness benefits by patients with metastatic breast cancer-A Swedish cohort study.

ObjectiveThe objective of this study is to determine the prevalence and predictors of sickness absence (SA) and disability pension (DP) in women with metastatic breast cancer (mBC).MethodsData were obtained from Swedish registers concerning 1,240 adult women diagnosed 1997–2011 with mBC, from 1 year before (y−1) to 2 (y1) and 2 (y2) years after diagnosis. SA and DP prevalence was calculated. Odds ratios (AOR) were determined for factors associated with using long‐term (SA > 180 days or DP > 0 days) sickness benefits.ResultsPrevalence of SA and DP was 56.0% and 24.8% during y−1, 69.9% and 28.9% during y1, and 64.0% and 34.7% during y2, respectively. Odds of using long‐term sickness benefits were higher y1 and y2 in patients using long‐term sickness benefits the year before diagnosis (AOR = 3.82, 95% CI 2.91–5.02; AOR = 4.31, 95% CI 2.96–6.29, respectively) and y2 in patients with mBC diagnosis 1997–2000 (AOR = 1.84, 95% CI 1.10–3.08) and using long‐term sickness benefits the year after diagnosis (AOR = 22.10, 95% CI 14.33–34.22).ConclusionsThe prevalence of sickness benefit utilisation was high and increased after mBC diagnosis, particularly for patients using long‐term sickness benefits prior to diagnosis. Additional study is needed to determine factors that might reduce the need for sickness benefits and enhance work ability in these patients.

Work incapacity and psychiatric patient care following attempted suicide - a cohort study of 65 097 Swedish twins.

Research is scarce on the role of familial factors and previous psychiatric care on the association between suicide attempt and future work incapacity as well as deterioration in mental health. We aimed to investigate the associations between suicide attempt and sickness absence, disability pension and psychiatric patient care and to study the influence of previous psychiatric care and familial factors (genetics and shared environment) on the associations. The study included 65 097 twins living in Sweden on 31st of December 2006, aged 19-60 years. The twins were followed 2007-2013 regarding sickness absence, disability pension, inpatient care or specialized outpatient care for a mental diagnosis. Cox regression models were performed for the whole sample, and conditional models for discordant twin pairs. The analyses were also stratified by psychiatric care before 2007. We found that suicide attempt predicted sickness absence, disability pension, and future mental diagnosis among the whole sample. The discordant twin pair analyses showed that the association between suicide attempt and sickness absence or disability pension was influenced by familial factors. Stratified analyses of individuals with or without psychiatric care before 2007 showed that previous psychiatric care had some impact on the associations. A suicide attempt is a risk factor for work incapacity and psychiatric patient care. Familial factors and previous psychiatric care play a role in the associations between attempting suicide and work incapacity as well as psychiatric patient care. These factors are important when developing measures preventing work incapacity among those with a suicide attempt.

Predictors of Sickness Absence in a Clinical Population With Chronic Pain

Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-representative sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PerspectiveThis study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs.

Pain catastrophizing, kinesiophobia and fear-avoidance in non-specific work-related low-back pain as predictors of sickness absence.

The influence of pain catastrophizing, kinesiophobia and fear-avoidance attitudes towards non-specific low-back pain has been scarcely studied in an occupational insurance provider context. The objective of this work is to ascertain the relationship between these psychosocial variables with work absence, its duration and the disability of subjects with work-related low back pain. This is a descriptive observational methodological strategy. All patients with work-related non-specific low back pain who attended to an occupational health hospital during the study period were included consecutively. Clinical variables of kinesiophobia, pain catastrophizing, fear-avoidance attitudes, disability and pain were collected; sociodemographic variables of sex, age, type of work, educational level, occupational status and duration in days of work absence were recorded. Kinesiophobia (b = 1.43, P = 0.011, r = 0.333), fear-avoidance beliefs in its global dimension (b = 0.910, P = 0.014, r = 0.321), fear-avoidance beliefs in its work dimension (b = 1.255, P = 0.016, r = 0.321) and pain catastrophizing (b = 0.997, P = 0.013, r = 0.340) show individual association with the duration of sickness absence. Kinesiophobia (b = 0.821, P = 0.011, r = 0.30) and fear-avoidance beliefs (b = 1.760, P = 0.016, r = 0.28) are associated with disability (Kinesiophobia, b = 0.880, P = 0.045, r = 0.26; Fear-avoidance beliefs, b = 0.724, P = 0.010, r = 0.34). Kinesiophobia, fear-avoidance beliefs and pain catastrophizing are related to an increase in the duration of work absence and disability in patients with back pain in an occupational insurance provider context.

Education differences in sickness absence and the role of health behaviors: a prospective twin study

BackgroundLong-term sickness absences burden the economy in many industrialized countries. Both educational attainment and health behaviors are well-known predictors of sickness absence. It remains, however, unclear whether these associations are causal or due to confounding factors. The co-twin control method allows examining causal hypotheses by controlling for familial confounding (shared genes and environment). In this study, we applied this design to study the role of education and health behaviors in sickness absence, taking sex and cohort differences into account.MethodsParticipants were two cohorts of in total 8806 Norwegian twins born 1948 to 1960 (older cohort, mean age at questionnaire = 40.3, 55.8% women), and 1967 to 1979 (younger cohort, mean age at questionnaire = 25.6, 58.9% women). Both cohorts had reported their health behaviors (smoking, physical activity and body mass index (BMI)) through a questionnaire during the 1990s. Data on the twins’ educational attainment and long-term sickness absences between 2000 and 2014 were retrieved from Norwegian national registries. Random (individual-level) and fixed (within-twin pair) effects regression models were used to measure the associations between educational attainment, health behaviours and sickness absence and to test the effects of possible familial confounding.ResultsLow education and poor health behaviors were associated with a higher proportion of sickness absence at the individual level. There were stronger effects of health behaviors on sickness absence in women, and in the older cohort, whereas the effect of educational attainment was similar across sex and cohorts. After adjustment for unobserved familial factors (genetic and environmental factors shared by twin pairs), the associations were strongly attenuated and non-significant, with the exception of health behaviors and sickness absence among men in the older cohort.ConclusionsThe associations between educational attainment, health behaviors, and sickness absence seem to be confounded by unobserved familial factors shared by co-twins. However, the association between health behaviors and sickness absence was consistent with a causal effect among men in the older cohort. Future studies should consider familial confounding, as well as sex and age/cohort differences, when assessing associations between education, health behaviors and sickness absence.

Sickness absence and disability pension among swedish women prior to breast cancer relapse with a special focus on the roles of treatment and comorbidity.

ABSTRACTObjectiveWe aimed to determine the longitudinal prevalence and the predictors of sickness absence (SA) and disability pension (DP) in breast cancer (BC) women who eventually developed relapse.MethodsA total of 1293 BC women, who were ages 20–63 years, diagnosed between 1996 and 2011 and by 2016 had all developed relapse, were identified in Swedish registers and were followed from two years before to five years after their primary diagnosis, while they were relapse‐free. Annual prevalence of SA and DP was calculated. Logistic regression was used to estimate adjusted odds ratios (AOR) for long‐term SA (>30 days) at one (y1) and three (y3) years post‐diagnosis.ResultsPrevalence of long‐term SA was 68.1% in y1 and 16.3% in y5. Prevalence of DP progressively increased from 16.3% in y1 to 29.0% in y5. Predictors of long‐term SA included age <50 years (y1:AOR = 1.79 [1.39–2.29]), TNM stage III (y1:AOR = 1.54 [1.03‐2.31]; y3:AOR = 2.21 [1.32–3.72]), metastasis (y1:AOR = 1.64 [1.26–2.12]; y3:AOR = 1.51 [1.05–2.18]), comorbidity (y1:AOR = 2.41 [1.55–3.76]; y3 AOR = 4.62 [2.49–8.57]) and any combination of radiotherapy, chemotherapy and hormonal therapy (y1:AOR = 2.05–5.71).ConclusionAmong BC women who later developed relapse, those who had higher stages of BC, had comorbidity and received neoadjuvant and/or adjuvant therapy were at significantly higher risk of needing long‐term SA after their diagnosis.

Subjective cognitive complaints and sickness absence: A prospective cohort study of 7059 employees in primarily knowledge-intensive occupations.

Knowledge-intensive work requires capabilities like monitoring multiple sources of information, prioritizing between competing tasks, switching between tasks, and resisting distraction from the primary task(s). We assessed whether subjective cognitive complaints (SCC), presenting as self-rated problems with difficulties of concentration, memory, clear thinking and decision making predict sickness absence (SA) in knowledge-intensive occupations. We combined SCC questionnaire results with reliable registry data on SA of 7743 professional/managerial employees (47% female). We excluded employees who were not active in working life, on long-term SA, and those on a work disability benefit at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome measure was the accumulated SA days during a 12-month follow-up. We used a hurdle model to analyse the SA data. SCC predicted the number of SA days during the 12-month follow-up. The ratio of the means of SA days was higher than 2.8 as compared to the reference group, irrespective of gender, with the lowest limit of 95% confidence interval 2.2. In the Hurdle model, SCC, SA days prior to the questionnaire, and age were additive predictors of the likelihood of SA and accumulated SA days, if any. Subjective cognitive complaints predict sickness absence in knowledge-intensive occupations, irrespective of gender, age, or general health. This finding has implications for supporting work ability (productivity) among employees with cognitively demanding tasks.

Socioeconomic Differences in Occupational Health Service Utilization and Sickness Absence Due to Mental Disorders: A Register-Based Retrospective Cohort Study.

Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18–34 years (N = 6545) and 35–54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18–34 year old employees; and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35–54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.

Self-reported health problems and obesity predict sickness absence during a 12-month follow-up: a prospective cohort study in 21 608 employees from different industries

ObjectivesTo study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries.MethodsThe results of a health risk appraisal (HRA) were combined with archival data of...

Sickness Absence of Nurses Working in Residential Elder Care: The Essential Role of Psychosocial Job Resources and Home Demands.

To elucidate the role and pathways of psychosocial home demands, psychosocial home resources, and psychosocial job resources in relation to sickness absence among nurses working in residential elder care. Longitudinal (SEM) analyses with bootstrapping with a 1 year follow-up among 365 nurses were performed. Survey data and registered sickness absence data were used. A complete mediation model showed the best fit. More psychosocial job resources (β = -1.50) like "work schedule fit with private life" predicted less and more psychosocial home demands (β = 0.62) predicted more psychosomatic health complaints. The job resources and home demands predicted sickness absence duration and episodes 1-year later mediated through nurses' health. More attention is needed for nurses' work schedule fit with private life and their home demands to potentially reduce health-related sickness absence among nurses working in residential elder care.

Sickness Absence due to Chronic Musculoskeletal Pain: The Exploration of a Predictive Psychological Model Including Negative Moods, Subjective Health and Work Efficacy in an Adult County Population (The HUNT Study).

The relation between musculoskeletal pain and sickness absence was tested in an adult county population. Maximal explained variance in absence from work due to chronic musculoskeletal pain (sickness absence) was tested in a model in which subjective health was expected to mediate the associations between such pain and dysphoria, respectively, and work efficacy. In turn, work efficacy was expected to mediate the link between subjective health and sickness absence. All the residents in the County of Nord-Trøndelag, Norway, aged 20 and older, were invited to take part in a public health survey during 1995-97 (HUNT-2), and 66,140 (71.2%) participated. Prevalence of musculoskeletal pain, dysphoria, subjective health and work efficacy were assessed, as well as sickness absence last year due to musculoskeletal pain. The model test was performed by use of the LISREL procedure based upon data from 30,158 employees reporting chronic musculoskeletal pain last year. The measurement model fitted the data well: χ2 = 9075, df = 52, p < .0004, Critical N = 1041, RMSEA = 0.038, CFI = 0.99, SRMR = 0.020. The structural model fitted the data equally well, and the best prediction of sickness absence was obtained with lower back pain, upper and lower extremity pain, as well as dysphoria as the primary variables affecting subjective health that, in turn, was the convergent predictor of work efficacy that, finally, best explained the variance in sickness absence (56%). The data supported an indirect sequence of complaint-health-efficacy (CHE-model) as the best predictor of sickness absence due to musculoskeletal pain.

Bio-mathematical fatigue models predict sickness absence in hospital nurses: An 18 months retrospective cohort study

This study examined the associations between bio-mathematical fatigue-risk scores and sickness absence (SA) in hospital nurses over 18 months. Work schedules and SA data were extracted from the hospital's attendance system. Fatigue-risk scores were generated for work days using the Fatigue Audit InterDyne (FAID) and Fatigue Risk Index (FRI). Over the study period, 5.4% of the shifts were absence shifts. FAID-fatigue ranged from 7 to 154; scores for a standard 9–5 work schedule can range from 7 to 40. Nurses with high FAID-scores were more likely to be absent from work when compared to standard FAID-scores (41–79, OR = 1.38, 95%CI = 1.21–1.58; 80–99, OR = 1.63, 95%CI = 1.37–1.94 and ≥ 100, OR = 1.73, 95%CI = 1.40–2.13). FRI-fatigue ranged from 0.9 to 76.8. When FRI-scores were >60, nurses were at 1.58 times (95%CI = 1.05–2.37) at increased odds for SA compared to scores in the 0.9–20 category. Nurse leaders can use these decision-support models to adjust high-risk schedules or the number of staff needed to cover anticipated absences from work.

Emotional Dissonance and Sickness Absence Among Employees Working With Customers and Clients: A Moderated Mediation Model via Exhaustion and Human Resource Primacy.

Emotional dissonance, i.e., a discrepancy between required and felt emotions, has been established as a predictor of sickness absence in studies, but little is known about mechanisms that can explain this association. In order to prevent and reduce the impact of emotional dissonance on sickness absence, there is a need for greater attention to variables explaining when and how emotional dissonance is related to sickness absence. The overarching aim of this study was to examine whether emotional dissonance has an indirect association with sickness absence through exhaustion. In addition, we examined whether human resource primacy (HRP), which is the employer’s degree of concern for human resources, moderates this indirect effect. A sample of 7758 employees, all working with customers and clients, were recruited from 96 Norwegian organizations. Emotional dissonance, exhaustion, and HRP were measured through surveys and then linked to registry data on medically certified sickness absence for the year following the survey assessment. Results showed that exhaustion is a mediator for the relationship between emotional dissonance and sickness absence. Furthermore, higher levels of HRP were found to reduce the positive association between emotional dissonance and exhaustion, and the indirect effect of emotional dissonance on sickness absence through exhaustion is found to be weaker when HRP is high. By testing this moderated mediation model, the current study contributes to the literature on emotion work by clarifying mechanisms that are crucial for the development of targeted interventions that aim to reduce and prevent sickness absence in client-driven work environments.

Association Between Cortisol to DHEA-s Ratio and Sickness Absence in Japanese Male Workers

This study aimed to investigate the association between serum levels of cortisol and dehydroepiandrosterone sulfate (DHEA-s) and sickness absence over 2years in Japanese male workers. A baseline survey including questions about health behavior, along with blood sampling for cortisol and DHEA-s, was conducted in 2009. In total, 429 men (mean ± SD age, 52.9 ± 8.6years) from whom blood samples were collected at baseline were followed until December 31, 2011. The hazard ratios (HR) and 95% confidence intervals (CI) for sickness absence were calculated using a Cox proportional hazard model, adjusted for potential confounders. Among 35 workers who took sickness absences, 31 had physical illness. A high cortisol to DHEA-s ratio increased the risk of sickness absence (crude HR = 2.68, 95% CI 1.12-6.41; adjusted HR = 3.33, 95% CI 1.35-8.20). The cortisol to DHEA-s ratio was linearly associated with an increased risk of sickness absence (p for trend < .050). Single effects of cortisol and DHEA-s levels were not associated with sickness absences. This trend did not change when limited to absences resulting from physical illness. Hormonal conditions related to the hypothalamus-pituitary-adrenocortical axis and adrenal function should be considered when predicting sickness absence. The cortisol to DHEA-s ratio may be more informative than single effects of cortisol and DHEA-s levels.