Short Sickness Absence Research Articles

Associations of depressive symptoms and psychosocial working conditions with sickness absences in a Finnish cohort of 11,495 employees

ObjectiveTo examine the relevance of questions on psychosocial working conditions and depressive symptoms, as used in a screening questionnaire in preventive occupational health care, to predict repetitive short or long sickness absences. MethodsThe participants were 11,495 employees of various occupations in Finnish companies. The data were prospectively collected by one occupational healthcare service provider (Finla) and included register data of sickness absences and responses to a questionnaire used in pre-employment and periodic health examinations between 2011 and 2019. Long sickness absences of > 30 days and repetitive short sickness absences of one to ten days in a 24-month follow-up were used as outcome variables for multiple logistic regression analysis. ResultsStrong associations were found between repetitive short and long sickness absences, and the questions on depressive symptoms “felt hopeless about the future”, “felt melancholic”, “felt everything was an effort”, and “feelings of worthlessness”. Among questions on psychosocial working conditions, strong associations were found between sickness absences and questions on decision authority, self-reformation opportunities, job versatility, and appreciation for their work. ConclusionsQuestionnaires on depressive symptoms and psychosocial work environment can help identify patients with an increased risk of sickness absence. Data accumulating in occupational health care should be used more systematically to reduce the risk of work disability through targeted occupational health interventions.

Workload and short sickness absences in a cohort of Finnish hospital employees.

This article used register data on day-to-day working hours of hospital employees combined with patient characteristics at work unit (wards) level to measure workload and its implications for short, self-certified sickness absences. We measured statistically the average nursing treatment burden of different patient mixes in hospital wards, and then analyzed the overall workload (intensity) of working days by comparing it to the actual available nursing workforce. We found that a significant part of the workload variation occurred between working days, and it was related to unexpected changes in the number of employees. In atypical situations a long work shift was associated with caring for patients with fewer resources. The high workload of a day increased the risk of short sickness absences along the following 3-week period. The results show that managing short-term workload variability should be a key aim from the perspective of well-being at work, and that combining different data sources can provide novel, important insights to the measurement of workload.

Work-family conflicts and sickness absence-a register-linked cohort study among young and early midlife employees.

Work-family conflicts (WFC) have been associated with poor mental health, poor self-rated health and sickness absence. However, studies on short sickness absence are lacking and more information is needed also about long sickness absence regarding the direction of WFC, and potential explaining factors particularly among young and early middle-aged employees. The Helsinki Health Study baseline survey (2017) among 19- to 39-year-old municipal employees (N = 3683, 80% women, response rate 51.5%) was linked to employer's sickness absence data. The associations of work-to-family conflicts (WTFC) and family-to-work conflicts (FTWC) with short (1-7 days) and long (over 7 days) sickness absence were analyzed using negative binomial regression analysis. Covariates were age, gender, family-related factors and work-related factors. Stratified analyses by occupational class were performed. The results are presented as rate ratios and their 95% confidence intervals. High WTFC were associated with short (1.25, 1.12-1.40) and long (1.37, 1.11-1.70) sickness absence. High FTWC were also associated with short (1.12, 1.03-1.22) and long (1.24, 1.06-1.45) sickness absence. Adjustment for family-related factors strengthened the associations, whereas adjustment for work-related factors abolished the associations between WTFC and sickness absence. Associations between WFC and sickness absence were observed among two lowest occupational classes only. WFC are associated with both short and long sickness absence. Work-related factors including the quality of supervisory work and shift work play a role in the association. Intervention studies could determine if improvements in combining work and family life lead to a reduction in sickness absence.

The Joint Contributions of Overweight/Obesity and Physical and Mental Working Conditions to Short and Long Sickness Absence among Young and Midlife Finnish Employees: A Register-Linked Follow-Up Study

Introduction: Overweight/obesity and strenuous working conditions are associated with work disability, but their joint contributions to sickness absence (SA) are unknown. We aimed to examine their joint contributions to SA periods of 1–7 and ≥8 days. Methods: Self-reported data on body mass index and working conditions, including perceived physically and mentally strenuous work and hours per day spent in heavy physical work, were linked to the employer’s SA register for the City of Helsinki, Finland, employees (n = 4,323, women 78%) who were 19–39 years old at baseline. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for SA periods using negative binomial regression models among participants with healthy weight and overweight/obesity, with and without exposure to strenuous working conditions. The mean follow-up time was 2.1 years. Results: Participants with overweight/obesity and exposure to physically strenuous working conditions had the highest age- and gender-adjusted RRs for SA periods of both 1–7 and ≥8 days (physically strenuous work: RR: 1.38, CI: 1.25–1.52, and RR: 1.87, CI: 1.60–2.18, respectively; ≥3 h per day spent in physical work: RR: 1.40, CI: 1.26–1.55 and 2.04, CI: 1.73–2.40, respectively). The interaction between overweight/obesity and physically strenuous working conditions was additive for SA periods of 1–7 days and weakly synergistic for SA periods of ≥8 days. For mentally strenuous work, participants with overweight/obesity and exposure to mentally strenuous work had the highest age-adjusted RRs for SA periods of ≥8 days, and the interaction was additive. Conclusion: The joint contributions of overweight/obesity and exposure to strenuous working conditions to SA should be considered when aiming to reduce employees’ SA. Employers might benefit from providing employees adequate support for weight management and adherence to healthy lifestyles while improving employees’ working conditions.

Organizational injustice and sickness absence: The moderating role of locked-in status

Organizational injustice is known to negatively affect employees’ health and to increase the risk for sickness absence. The negative health effects are also known to be more pronounced in uncontrollable, strain increasing, situations at the workplace. This study tests whether locked-in status, i.e., being stuck in a non-preferred workplace, modifies the associations between injustice perceptions and frequent (≥2 times/yr) and long (≥ 8 days/yr) sickness absence. The sample contained 2631 permanent employees from the Swedish Longitudinal Occupational Survey of Health in 2018 and 2020. Multigroup structural equation modelling was used to compare the proposed relationships between employees who are locked-in in their workplace and employees who are not. We found a positive association between higher overall organizational injustice and long sickness absence two years later, with the association being stronger for the locked-in group. Also, higher injustice was associated with more frequent sickness absence, but only for those not being locked-in.Employees being locked-in seem to have higher risk of long-term sickness absence which might indicate more serious health problems. Employees not being locked-in more often take short sickness absence, which could indicate a coping behaviour to handle high strain. This study adds knowledge to the role of locked-in status as a moderator in the much-studied relationship between organizational justice and health as well as to the multiple reasons underlying sickness absence.

The Time-Varying Effect of Participatory Shift Scheduling on Working Hour Characteristics and Sickness Absence: Evidence from a Quasi-Experiment in Hospitals.

Participatory shift scheduling for irregular working hours can influence shift schedules and sickness absence. We investigated the effects of using participatory shift scheduling and shift schedule evaluation tools on working hour characteristics and sickness absence. We utilized a panel data for 2015-2019 with 16,557 hospital employees (6143 in the intervention and 10,345 in the control group). Difference-in-differences regression with ward-level clustered standard errors was used to estimate the average treatment effect on the treated coefficients relative to timing of the intervention with 95% confidence intervals (CI). Using participatory scheduling tool increased long working hours and weekend work and had delayed effects on the short (1-3 days) sickness absences. Increased effects were observed: 0.2 [95% CI 0.0-0.4] days for the second, and 0.8 [95% CI 0.5-1.0] for the third year after the onset of intervention. An average increase of 0.5 [95% CI 0.1-0.9] episodes on all sickness absence episodes was observed for the third year. Using the shift schedule evaluation tool with the participatory shift scheduling tool attenuated the adverse effects. To conclude, participatory shift scheduling increased some potentially harmful working hour characteristics but its effects on sickness absence were negligible, and further attenuated by using the shift schedule evaluation tool.

Associations between perceptions and sick leave duration in dyads of workers and significant others

Abstract Background Dyadic processes of workers and significant others like partners, family members and friends can play an important role in adaptation to chronic disease, thereby influencing health and work outcomes. This study aimed to increase our understanding of dyadic processes in sick leave duration of workers with chronic diseases. We examined illness perceptions, return to work expectations (RTWE) and perceptions about significant other responses (i.e., engagement, buffering and overprotection) of workers and their significant others in relation to sick leave duration. Methods This study used survey and registry data of 90 dyads of sick-listed workers with a chronic disease and their significant others. Simple and multiple regressions in which perceptions of workers and significant others were included simultaneously were used to examine associations with sick leave duration. Results Workers’ and significant others’ perceptions were moderately to strongly correlated (r ranged from .46 to .80). Sick leave duration was associated with illness perceptions of both workers (b = 8.58, p=.001) and significant others (b = 6.46, p=.008), with more negative illness perceptions associated with a longer sickness absence. In the multiple regression, illness perceptions explained 12.3% of the variation in sick leave duration. Sick leave duration was also associated with RTWE of workers (b=-76.87, p<.001) and their significant others (b=-92.47, p<.001), with more positive RTWE associated with a shorter sickness absence. The RTWE of dyad members accounted for 24.5% of the variance of sick leave duration. Conclusions Illness perceptions and RTWE of workers and their significant others are strongly interdependent and associated with sick leave duration of workers with chronic diseases. A dyadic approach targeted at improving illness perceptions and RTWE of both workers and significant others might be more effective than an individualistic approach in preventing long-term sickness absence. Key messages • Return to work expectations and illness perceptions of workers and their significant others are associated with the duration of sickness absence of workers with chronic diseases. • A dyadic approach targeted at both workers and their significant others might be more effective than an individualistic approach in the prevention of long-term sickness absence.

Cannabis Use Increases the Risk of Sickness Absence: Longitudinal Analyses From the CONSTANCES Cohort.

AimsTo examine the longitudinal associations between cannabis use and risks of short (<7 days), medium (7-28 days), and long (>28 days) sickness absences at one-year follow-up.Methods87,273 participants aged 18-65 years from the French CONSTANCES cohort reported their frequency of cannabis use at inclusion between 2012 and 2018. Sickness absences occurring during one year of follow-up were collected from national medico-administrative registries. Multivariable generalized linear regressions were used to compute the Odds Ratios (OR) with their 95% Confidence Intervals (CI) of having at least one sickness absence at follow-up compared to no sickness absence, while controlling for sociodemographic factors, chronic conditions and occupational factors.ResultsCannabis use more than once a month was associated with an increased risk of short (OR, [95% CI]: 1.56 [1.32–1.83]) and medium (1.29 [1.07–1.54]) sickness absences at one-year follow-up, with dose-dependent relationships for short sickness absences (1.13 [1.08–1.18], p-for-trend <0.001). In stratified analyses, cannabis use was associated with an increased risk of sickness absences in older individuals, men, participants with good self-rated health, living or having lived as a couple, and having an open-ended contract.ConclusionsCannabis use prospectively increased the risk of short and medium sickness absences, even from once a month and with a dose-dependent relationship for short sickness absences. These findings should be considered in information and prevention public health campaigns to alert the general population and workers to this increased risk.

Health-promoting work schedules: protocol for a large-scale cluster randomised controlled trial on the effects of a work schedule without quick returns on sickness absence among healthcare workers

IntroductionIn shift work, quick returns refer to transitions between two shifts with less than 11 hours available rest time. Twenty-three per cent of employees in European countries reported having quick...

Association of working hour characteristics and on-call work with risk of short sickness absence among hospital physicians: A longitudinal cohort study

ABSTRACT Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians’ risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1–3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68–3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61–4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44–3.21) and a higher number of short (<11 h) shift intervals (OR for ≥5 versus none: 12.61, 95% CI 8.88–17.90) were all associated with the increased risk of short sickness absence. These associations did not differ between male and female physicians or between age groups. To conclude, the findings from objective working hour records show that long work shifts, on-call shifts and short shift intervals are related to the risk of short (1–3 days) sickness absence among hospital physicians.

Barriers and Facilitators for Return to Work from the Perspective of Workers with Common Mental Disorders with Short, Medium and Long-Term Sickness Absence: A Longitudinal Qualitative Study

Purpose Although common mental disorders (CMDs) highly impact individuals and society, a knowledge gap exists on how sickness absence can be prevented in workers with CMDs. This study explores: (1) workers’ perceived causes of sickness absence; (2) perceived return to work (RTW) barriers and facilitators; and (3) differences between workers with short, medium and long-term sickness absence. Methods A longitudinal qualitative study was conducted involving 34 workers with CMDs. Semi-structured interviews were held at two time-points during their RTW process. The 68 interviews were audio-taped, transcribed and thematically analyzed to explore workers’ perspective on sickness absence causes, RTW barriers and facilitators, and compare data across the three sub-groups of workers. Results Workers reported various causes for their absence, including: (1) high work pressure; (2) poor work relationships; (3) unhelpful thoughts and feelings, e.g. lacking self-insight; and (4) ineffective coping behaviors. According to workers, RTW was facilitated by work adjustments, fulfilling relationships with supervisors, and adequate occupational health guidance. Workers with short-term leave more often reported favorable work conditions, and proactive coping behavior. In contrast, the long-term group reported reactive coping behavior and dissatisfaction with their work. Conclusion Supporting workers with CMDs in gaining self-awareness and regaining control, discussing the value of their work, and creating work conditions that enable workers to do valuable work, seem central for successful RTW and might prevent sickness absence. Supervisors play a key role in enabling workers to do valuable work and further research should focus on how supervisors can be supported in this task.

Ethnic differences in risk of severe Covid-19: To what extent are they driven by exposure?

BackgroundThis study quantifies the risk of Covid-19 among ethnic groups of healthcare staff during the first pandemic wave in England.MethodsWe analysed data on 959 356 employees employed by 191 National Health Service trusts during 1 January 2019 to 31 July 2020, comparing rates of Covid-19 sickness absence in different ethnic groups.ResultsIn comparison with White ethnic groups, the risk of short-duration Covid-19 sickness absence was modestly elevated in South Asian but not Black groups. However, all Black and ethnic minority groups were at higher risk of prolonged Covid-19 sickness absence. Odds ratios (ORs) relative to White ethnicity were more than doubled in South Asian groups (Indian OR 2.49, 95% confidence interval (CI) 2.36–2.63; Pakistani OR 2.38, 2.15–2.64; Bangladeshi OR 2.38, 1.98–2.86), while that for Black African ethnicity was 1.82 (1.71–1.93). In nursing/midwifery staff, the association of ethnicity with prolonged Covid-19 sickness absence was strong; the odds of South Asian nurses/midwives having a prolonged episode of Covid-19 sickness absence were increased 3-fold (OR 3.05, 2.82–3.30).ConclusionsResidual differences in risk of short term Covid-19 sickness absences among ethnic groups may reflect differences in non-occupational exposure to SARS-CoV-2. Our results indicate ethnic differences in vulnerability to Covid-19, which may be only partly explained by medical comorbidities.

Frequent short sickness absence, occupational health service utilisation and long-term sickness absence due to mental disorders among young employees

ObjectivesWe examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees.MethodsWe used record-linkage data covering the young employees (< 35 years) of the City of Helsinki, Finland (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted.ResultsFSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA.ConclusionsBoth FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

The associations of working hour characteristics with short sickness absence among part- and full-time retail workers.

Objective:This study aimed to determine the associations of working hour characteristics with short (1–3 days) sickness absence (SA) among retail workers.Methods:As part of “RetailHours-project”, 4046 employees of 338 Finnish retail stores were included. Registry-based data on working hour characteristics and short SA were utilized. A case-crossover design was used and the odds ratios (OR) were controlled for the clustering effect and working hour characteristics.Results:There were strong dose–response relationships between percent of short (<11 hours) shift intervals and short SA among part- and full-time workers, men and women, and younger and older workers. Compared to workers without short shift intervals, the risk of SA was 1.47 times [95% confidence interval (CI) 1.29–1.68] higher among workers who had short shift intervals <10% of work times, 2.39 times (95% CI 2.03–2.82) higher among workers who had 10–25% of work times, and 4.03 times (CI 2.34–6.93) higher among workers who had short shift intervals >25% of work times. Weekly working hours >40 hours were associated with SA among part-time workers [odds ratio (OR) 2.22, CI 1.65–2.98], women (OR 1.62, CI 1.27–2.07) and among workers <30 years of age (OR 1.68, CI 1.20–2.35) as well as among workers aged ≥30 years (OR 1.43, CI 1.07–1.92). Furthermore, working mainly night shifts was associated with SA among full-time workers (OR 2.41, 95% CI 0.99–5.86) and women (OR 1.72, CI 1.02–2.89).Conclusions:A short shift interval is an important risk factor for short SA. Improving intervals between shifts and shortening long weekly working hours could reduce the risk of short SA among retail workers.

Predictors of working days lost due to sickness absence and disability pension

ObjectiveTo identify social and health-related predictors of the number of days lost due to sickness absence (SA) and disability pension (DP) among initially 55-year-old public-sector workers.MethodsThe data from the Finnish Helsinki Health Study included participants aged 55 years at the baseline (in 2000–2002, N = 1630, 81% women), and were enriched with register-based information on SA and DP. The cumulative number of calendar days lost due to SA ≥ 1 day or DP between ages 55 and 65 was calculated. Negative binomial regression model was used to identify the predictors of days lost.ResultsThe average calendar days lost was 316 days (about 220 working days) during a 10-year follow-up, and 44% were due to SA and 56% due to DP. Smoking [incidence rate ratio (IRR) = 1.19, 95% CI 1.01–1.40 for past and IRR = 1.30, CI 1.07–1.58 for current], binge drinking (IRR = 1.22, CI 1.02–1.46), lifting or pulling/pushing heavy loads (IRR = 1.35, CI 1.10–1.65), awkward working positions (IRR = 1.24, CI 1.01–1.53), long-standing illness limiting work or daily activities (IRR = 2.32, CI 1.93–2.79), common mental disorder (IRR = 1.52, CI 1.30–1.79), and multisite pain (IRR = 1.50, CI 1.23–1.84) increased the number of days lost, while high level of education (IRR = 0.66, CI 0.52–0.82) and moderate level of leisure-time physical activity (IRR = 0.80, CI 0.67–0.94) reduced the number of days lost.ConclusionsModifiable lifestyle risk factors, workload factors, common mental disorder, and multisite pain substantially increase the number of days lost. However, the findings of this study could be generalized to female workers in the public sector. Future research should also consider shorter SA spells in estimating working years lost and working life expectancy.

The effects of using participatory working time scheduling software on sickness absence: A difference-in-differences study

BackgroundParticipatory working time scheduling is a collaborative approach to scheduling shift work. As a potential way of improving work time control, it may provide a means to reducing sickness absence in shift work. So far, experimental and quasi-experimental studies on the effects of increased work time control on sickness absence are lacking. ObjectiveTo investigate the effects of using digital participatory working time scheduling software on ward-level sickness absence among Finnish hospital employees. Participants and methodsThis quasi-experimental study compared the amount of sickness absence in hospital wards using a participatory working time scheduling software (n=121 wards) and those continuing with traditional working time scheduling (n=117 wards) between 2014 and 2017. We used continuous panel data from 238 hospital wards with a total number of 9000 hospital employees (89% of women, primarily nursing staff). The ward-level measures consisted of number of employees, working hours, sickness absence spells per employee, and short (1–3) sickness absence days per employee. Two-way fixed effects and event study regressions with clustered standard errors were used to estimate the effect of using participatory scheduling software on sickness absence. ResultsSickness absence spells and short (1–3) sickness absence days decreased by 6% and 7%, respectively in the wards using participatory scheduling compared to those using traditional scheduling. The effect became stronger as the time measured in quarters of using the participatory working time scheduling software increased. ConclusionsThe effects of using participatory working time scheduling software indicated less ward-level sickness absence measured as spells and days in comparison to continuing with traditional scheduling. The encouraging findings are relevant not only to the health care sector but also to other sectors in which irregular shift work is a necessity.This study was registered with ClinicalTrials.gov (NCT02775331) before starting the intervention phase.

A case-crossover study of age group differences in objective working-hour characteristics and short sickness absence.

To investigate age group differences in objective working-hour characteristics and their associations with short (1-3days) sickness absence. Irregular working hours, that is shift work with non-standard schedule, may influence sickness absence rates in hospital workers. We collected daily working hours and the first incidence of short sickness absence from the employers' electronic records from 2008 to 2017. A case-crossover study compared the characteristics of the working hours 28days preceding the sickness absence (exposure window) and 28days earlier (control window) across 10-year age groups (conditional logistic regression for odds ratios (OR) with 95% confidence intervals (95% CI)). Younger employees had longer working hours and more night and consecutive shifts. Extended weekly working hours were associated with short sickness absence in all age groups. Age-related differences were few: extended working hours among oldest age group (OR: 1.01, 95% CI: 1.00-1.01) and daily working hours in the youngest and middle-age groups (Ors: 1.14-1.17) were associated with increased sickness absence. Length of working hours, and night and consecutive shifts differed between age, but the associations with short sickness absence were similar across all age groups. Among older employees, the length of working hours should be paid special attention.

Age-group differences in associations of working hour characteristics and short sickness absences

Abstract Background Working-hour characteristics are linked to disturbed sleep, but little is known about their association with short sickness absences (SA). We investigated the association between working hour characteristics in shift work and the incidence of short (1-3 days) SA in three age groups. Methods The data was from the hospitals’ electronic working time records. The final sample was restricted to the first incidence of short SA (1-3 days) from 2008 to 2015 and to shift working employees (n = 12156, 89% women). Age groups were &amp;lt; 35 (n = 5652), 35-49 (n = 3592) and ≤ 50 years (n = 2545). Work shifts (morning, day, evening, and night), quick returns (&amp;lt; 11 hours between two work shifts), length of work shift and weekly working time were calculated for case-crossover study design to compare the working hour characteristics of the 28 days preceding SA (exposure window) and those of the 28 days before the exposure window (control window). Conditional logistic regression models were run for odds ratios (OR) with 95% Confidence Intervals (95%CI). Results Working hour characteristics, especially length of working hours, played the clearest role among those &amp;lt; 35 years of age. In this age group, exposure to &amp;gt; 25% of &amp;gt; 40 weekly working hours associated with an increased likelihood of short SA (OR 1.30, 95%CI 1.17-1.44), whereas weekly working hours had OR 1.02 (95%CI 1.02-1.03). Having only a few (≤ 4) quick returns decreased the likelihood of SA (ORs 0.31-0.54), whereas having ≥25 quick returns increased it (OR 2.75, 95%CI 2.44-3.11). The results showed mostly similar trends among those of 35-49 years of age whereas among older workers (≤ 50 years) only an association for quick returns was observed. Conclusions Long working hours increase the risk of short SA among those ≤ 49 years of age and several quick returns among all age groups. These working-hour characteristics should be avoided to minimize SA and increased costs for the employer, but also to maintain public health. Key messages Unhealthy working-hour characteristics should be paid special attention in shift scheduling to avoid sickness absence. Good shift scheduling could assist in maintaining workability and therefore public health.

Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial

IntroductionDepression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However,...

Exposure to working-hour characteristics and short sickness absence in hospital workers: A case-crossover study using objective data

IntroductionShift work characteristics, such as the number of night shifts or quick returns, are linked to disturbed sleep and greater work-life conflict, but little is known about their association with short sickness absences. Studies utilizing objective working-hour characteristic data can provide knowledge on specific shift work characteristics that may associate with sick leave. We investigated the association between working-hour characteristics in shift work and the incidence of short (1–3 days) sickness absences. Participants and methodsThe individual-level data were collected from the employers’ electronic working time records of the Finnish Public Sector study. The final analytical sample was restricted to the first incidence of short sickness absence (1–3 days) from January 1, 2008 to the end of 2015. We studied employees with shift work contracts (n = 12 156) and day work contracts (n = 6225). Of these, 89% were female workers, with a mean age of 37.1 years, and 12% worked part-time. We calculated type of shift (morning, day, evening, and night), quick returns (< 11 h between two work shifts), length of work shift and weekly working time. We utilized case-crossover study design to compare the working-hour characteristics of the 28 days preceding sickness absence (exposure window) and those of the 28 days before the exposure window (control window), using conditional logistic regression models for odds ratios with 95% Confidence Intervals (95%CI). ResultsExposure to ≥ 2, and especially ≥ 4 consecutive night shifts associated with an increased likelihood of short sickness absence (OR 1.24, 95%CI 1.12–1.38 and OR 1.54, 95%CI 1.10–2.15, respectively) among shift workers, whereas a high number (> 25%) of evening shifts and having ≥ 2 consecutive evening shifts associated with lower odds of sickness absence. Over 40-hour weeks (OR 1.29, 95%CI 1.20–1.39), over 48-hour weeks (OR 1.24, 95%CI 1.01–1.54) and quick returns (OR 1.02, 95%CI 1.01–1.02) increased the likelihood of sickness absence. Having only a few (0–1 or 2–3) quick returns over 28 days decreased the likelihood of sickness absence (ORs 0.46 and 0.67), whereas having ≥ 5 quick returns over 28 days increased it (OR 1.88, 95%CI 1.76–1.99). These associations were similar among both shift and day workers. ConclusionsLong working hours, several consecutive night shifts and quick returns increase the risk of short sickness absence. These working-hour characteristics should be avoided in shift scheduling to minimize sickness absence and increased costs for the employer.