Sickness Absence Rates Research Articles

Monetary Incentives vs. Monitoring in Addressing Absenteeism: Experimental Evidence

Exploiting two unexpected variations in sickness absence policy for civil servants in Italy, this paper assesses the relative importance of monitoring and monetary incentives in determining a basic measure of effort: presence at work. When stricter monitoring was introduced together with an average 20% cut in replacement rates for civil servants on short sick leave, sickness absence decreased by 26.4%, eliminating the wedge in absence rates with comparable private sector workers. The impact substantially decreased when a subsequent policy change brought back monitoring to the pre-reform level, while leaving monetary incentives untouched. Results are confirmed by a variety of robustness checks and are not driven by the presence of attenuation bias. No shift is detected in other types of absence as a consequence of the reforms. Given that sickness absence rates are higher in the public than in the private sector in the US and Western Europe as well, these results provide useful insights on how to draw a successful strategy for addressing absenteeism.

Sickness absence.

Staff sickness levels in the NHS vary dramatically across the country, but the Audit Commission says that by understanding and tackling the factors causing some of this variation the NHS can increase staff productivity, improve morale and save £290 million. It has produced a briefing that examines the local variation and cost of sickness absence to primary care trusts, NHS trusts and foundation trusts, and outlines where organisations can find more help and advice in cutting sickness absence rates.

NICE guidance on long-term sickness and incapacity

Long-term sickness absence and incapacity benefits (disability pension) rates have increased across industrialised countries. Effective measures are needed to support return to work. The recommendations of this guidance were informed by the most appropriate available evidence of effectiveness and cost-effectiveness. Public health evidence was provided by research using a variety of study designs that attempted to determine the outcome of a particular intervention by evaluating status before and after the intervention had been effected, and was not limited to randomised control trials. Where the evidence base was depleted or underdeveloped, expert witnesses were called to give their opinion on the best available evidence and emerging interventions. The process enabled challenge and contestability from stakeholder groups at different points as the guidance was developed. Forty-five heterogeneous studies were included in the review of interventions to reduce long-term sickness absence and transitions from short-term to long-term absence (mainly covering the former and also mainly examining musculoskeletal conditions). The analysis of evidence was restricted to descriptive synthesis. Three general themes emerged from an analysis of the studies that were more likely to report positive results: early interventions; multidisciplinary approaches; and interventions with a workplace component. Two further reviews were undertaken, one on interventions to reduce the re-occurrence of sickness absence, which identified seven studies on lower back pain, and concluded that early intervention and direct workplace input are important factors. The final evidence review focused on six studies of interventions for those in receipt of incapacity benefit. The evidence was that work-focused interviews coupled with access to tailored support are effective and cost-effective interventions. Practitioners should consider the impact of interventions and management options on work ability for patients of working age. Work ability should be considered a key outcome for future intervention studies.

Sickness Absence as an Indicator of Health in Sweden

AbstractFor many years Sweden has experienced high rates of sickness absence among employees. Sickness absence is often regarded as an indicator of health in a population, with low rates of absence associated with good health and high degrees of absence associated with poor health. The aim of this article is to examine this hypothesis — that the high rates of sickness absence in Sweden is an indicator of poor health. Sickness absence and health data was obtained from official government statistics in order to compare Sweden with six other European countries and a number of health-related variables. The hypothesis was not supported by the results of this study. While Sweden has a high rate of sickness absence, it ranks highly on a range of health variables when compared to other European countries. Instead, sickness absence may be more strongly associated with rates of unemployment. In times of high unemployment, sickness absence is low, and in times low unemployment, sickness absence is high. While public health programs are essential components of primary health care initiatives, the evidence from this study indicates that they are unlikely to have significant impact on sickness absence in Sweden. Instead more effort should be made to intervene early following sickness absence through providing timely vocational rehabilitation and disability management programs.

Sickness presenteeism in Spanish-born and immigrant workers in Spain

BackgroundPrevious studies have shown that immigrant workers face relatively worse working and employment conditions, as well as lower rates of sickness absence than native-born workers. This study aims to assess rates of sickness presenteeism in a sample of Spanish-born and foreign-born workers according to different characteristics.MethodsA cross-sectional survey was conducted amongst a convenience sample of workers (Spanish-born and foreign-born), living in four Spanish cities: Barcelona, Huelva, Madrid and Valencia (2008-2009). Sickness presenteeism information was collected through two items in the questionnaire ("Have you had health problems in the last year?" and "Have you ever had to miss work for any health problem?") and was defined as worker who had a health problem (answered yes, first item) and had not missed work (answered no, second item). For the analysis, the sample of 2,059 workers (1,617 foreign-born) who answered yes to health problems was included. After descriptives, logistic regressions were used to establish the association between origin country and sickness presenteeism (adjusted odds ratios aOR; 95% confidence interval 95%CI). Analyses were stratified per time spent in Spain among foreign-born workers.ResultsAll of the results refer to the comparison between foreign-born and Spanish-born workers as a whole, and in some categories relating to personal and occupational conditions. Foreign-born workers were more likely to report sickness presenteeism compared with their Spanish-born counterparts, especially those living in Spain for under 2 years [Prevalence: 42% in Spanish-born and 56.3% in Foreign-born; aOR 1.77 95%CI 1.24-2.53]. In case of foreign-born workers (with time in Spain < 2 years), men [aOR 2.31 95%CI 1.40-3.80], those with university studies [aOR 3.01 95%CI 1.04-8.69], temporary contracts [aOR 2.26 95%CI 1.29-3.98] and salaries between 751-1,200€ per month [aOR 1.74 95% CI 1.04-2.92] were more likely to report sickness presenteeism. Also, recent immigrants with good self-perceived health and good mental health were more likely to report presenteeism than Spanish-born workers with the same good health indicators.ConclusionsImmigrant workers report more sickness presenteeism than their Spanish-born counterparts. These results could be related to precarious work and employment conditions of immigrants. Immigrant workers should benefit from the same standards of social security, and of health and safety in the workplace that are enjoyed by Spanish workers.

Sickness absence in student nursing assistants following a preventive intervention programme

We have previously shown that a multidimensional programme combining physical training, patient transfer techniques and stress management significantly reduced sickness absence rates in student nurse assistants (NAs) after 14 months of follow-up. At follow-up, the control group had reduced SF-36 scores for general health perception [general health (GH)], psychological well-being [mental health (MH)] and energy/fatigue [vitality (VT)] compared with the intervention group, which remained at the baseline level for all three measures. To ascertain whether this effect remained after a further 36 months of follow-up and to analyse the association of GH, MH and VT scores with sickness absence. This was a cluster randomized prospective study. The original study involved assessment at baseline and follow-up at 14 months (the duration of the student NA course). Of 568 subjects from the original intervention study, 306 (54%) completed a postal questionnaire at 36 months. Sickness absence increased in both groups between the first and second follow-up. At the second follow-up, the intervention group had a mean of 18 days of sickness absence compared with 25 in the control group but this was not significant. GH at 14 months follow-up was found to predict sickness absence levels after 3 years. MH and VT scores showed an inverse association with sickness absence but the results were not significant. The results suggest that the initial intervention did not have a sustained effect on sickness absence 36 months after initial follow-up of the study group.

Validierung einer syndromischen Surveillance akuter Respirationstrakt-Erkrankungen in Kindergärten und Kindertagesstätten Schleswig-Holsteins (SHARE)

To obtain reliable, regionalized, and timely data for the spread of seasonal influenza in various age groups, which are preferentially affected by the influenza virus, a syndromic surveillance system for acute respiratory tract infections in Schleswig-Holstein (SHARE) was established in preschools and nurseries starting in 2006. The Schleswig-Flensburg district with 12 of 114 preschools and nurseries and 850 of 5,750 supervised children served as a pilot district. The weekly rates of sickness absenteeism correlated most strongly with the onset of seasonal influenza and with population density during the first half of the year. Mean annual sickness absenteeism levels of above 6% occurred more frequently above a population density of 200 inhabitants/km(2) than below this density (relative risk 2.50, 95% confidence interval 1.18-5.32). By analysis of the receiver-operating characteristic curve, the diagnostic performance of the SHARE system as a classifier for seasonal influenza was determined. The sensitivity was 83% and the specificity was 79% when sickness absence rates exceeded 5%. The performance of the SHARE system correlated with the size of the kindergarten. In 2008, 13 of 15 districts of Schleswig-Holstein participated with 157 of 1,684 kindergarten and 10,300 of 113,000 children. The evaluation for 2008 confirmed that the SHARE system is suitable for the surveillance of seasonal influenza at the district and state levels.

Discrepancy between objective and subjective measures of job stress and sickness absence

The aim of this study was to examine the association of the discrepancy between externally and self-assessed measures of work environment with long- and short-term sickness absence. The study population included 6997 middle-aged men and women from the Whitehall II cohort, whose work characteristics were examined at baseline (1985-1988) through both an external evaluation and self-report, with a follow-up of up to 13 years of sickness absence reporting from administrative records. The primary exposure of interest was the discrepancy between measures of work stress for fast job pace, conflicting demands, and decision latitude. In mutually adjusted models, external measures of job characteristics were more strongly associated with higher rates of sickness absence compared with self-assessed measures, for both lower frequency of fast work pace and lower conflicting demands (i.e., "passive" levels). Individuals who self-reported higher frequencies of fast work pace and conflicting demands than were reported through external assessment had higher rates of short-term sickness absence [incident rate ratios (IRR) of 1.13 (95% confidence interval [95% CI] 1.11-1.15) and IRR 1.14 (95% CI 1.11-1.16), respectively]. There was no difference in rates of sickness absence found for decision latitude [IRR 1.02 (95% CI 1.00-1.04)]. Our findings demonstrate that the discrepancy between externally and self-assessed job demand measures have additional predictive power beyond each individual measure of job structure, which may be related to the extent of cognitive and emotional processing of assessment questions as compared to decision latitude measures.

Sickness Absence among Immigrants in Norway, 1992—2003

Utilizing register panel data (1992—2003), in this article we study long-term sickness absence among immigrants and ethnic Norwegians ( n = 200,022). The data contain detailed information on socio-economic background, labour market participation and social insurance benefits for all individuals aged between 16 and 67 years residing in Norway. We present four main findings: (1) There is no difference in sickness absence between ethnic Norwegians and immigrants from the other Nordic countries, Western and Eastern Europe after controlling for demographic, socio-economic and labour market factors; (2) the sickness absence rates are higher among individuals from Asia (men and women) and Africa (men), and lower among men from North America and Oceania compared with ethnic Norwegians; (3) second-generation immigrants share the same level of sickness absence as ethnic Norwegians; (4) residence time has a curve-linear effect (reversed U-shape) on sickness absence for most immigrant groups. We discuss the findings in relation to the reason for emigrating, health risks related to immigration, social exclusion and norms towards sickness absence.

The predictive capacity of declared musculoskeletal disorder at pre-employment screening

This study was undertaken at a major UK airport in response to management concerns about levels of sickness absence and impaired work capacity in the security department in order to investigate the possibility of achieving reductions through changes in pre-employment screening procedures. To determine the predictive capacity of a declared musculoskeletal disorder (MSD) at pre-employment screening. This study was based on the pre-employment health declarations of security workers. Work outcomes measured included sickness absence rates (including total and MSD-related absence), work restriction and ill-health retirement rates. Pre-employment questionnaires (PEQs) were analysed for 594 individuals who joined as security staff from 1993-2002. Those who declared an MSD were compared with those who did not using data from the human resources department and the occupational health records. Subjects who disclosed MSDs at pre-employment had significantly higher rates of subsequent total absence, MSD-related absence and work restrictions compared with those who did not. Potential confounders included sex, smoking, age and years in employment. Pre-employment health screening can predict subsequent work outcomes. It is suggested that greater scrutiny is applied to declarations of an MSD at pre-employment screening in the potentially adverse manual handling environment of airport security work and that more advice is given to management about future risks of sickness absence and impaired work capacity.

When healthcare workers get sick: Exploring sickness absenteeism in British Columbia, Canada

To determine the demographic and work characteristics of healthcare workers who were more likely to take sickness absences from work in British Columbia, Canada. Payroll data were analyzed for three health regions. Sickness absence rates were determined per person-year and then compared across demographic and work characteristics using multivariate Poisson regression models. The direct costs to the employer due to sickness absences were also estimated. Female, older, full-time workers, long-term care workers and those with a lower hourly wage were more likely to take sickness absences and had similar trends with respect to the costs due to sickness absence. For occupations, licensed practical nurses, care aides and facility support workers had higher rates of sickness absence. Registered nurses, and those workers paid high hourly wages were associated with highest sickness related costs. It is important to understand the demographic and work characteristics of those workers who are more likely to take sickness absences in order to make sure that they are not experiencing additional hazards at work or facing detrimental workplace conditions. Policy makers need to establish healthy, safe and in turn more productive workplaces. Further research is needed on how interventions can reduce sickness absence.

Social protection and the employment contract: The impact on work absence

This study investigates the impact of temporary employment on all-cause sickness absence of one week or more with a focus on how this relationship is moderated by factors related to social protection (job tenure, union membership and firm size). A sample of 5,307 individuals who experienced 9,574 distinct job episodes was drawn from a longitudinal Canadian labour market survey (2000-2004). Duration analysis was undertaken to model the time from the start of a job to the first sickness absence. Specifically, a proportional hazard model was estimated using a complementary log-log function for continuous time processes. Findings showed that temporary employment was associated with a lower rate of sickness absence after controlling for tenure, prior health status, and several other individual and job characteristics. The results suggest that the lack of social protection in temporary jobs is a powerful determinant of absence taking, even in the case of serious health conditions that require an absence of one week or more.

Work Impairment and Disability in Posttraumatic Stress Disorder: A Review and Recommendations for Psychological Injury Research and Practice

Work impairment and disability are common consequences of posttraumatic stress disorder (PTSD), as reflected by significant rates of sickness absence, failure to return to work, and reduced work performance. Within the psychological injury field, the issue of work impairment and disability in PTSD often arises in workers’ compensation and disability insurance claims and in personal injury litigation. In this context, clinical and forensic practitioners are faced with challenges in rendering expert opinions on diagnosis, causality, prognosis, and recommendations for treatment and rehabilitation. To promote understanding of this important, yet understudied area, there are three aims of this paper: first, to review the current literature on work impairment and disability associated with PTSD; second, to draw on this literature to present a biopsychosocial framework of work impairment and disability in PTSD; and third, to offer suggestions for improving the assessment and management of PTSD-related work impairment and disability.

Interrelationships between education, occupational class, income and sickness absence

Socio-economic position measures, such as education, occupational class and income, are well-known determinants of health. However, previous studies have not paid attention to mutual interrelationships between these socio-economic position measures and medically confirmed sickness absence. The study is a register-based study. The participants were municipal employees of the City of Helsinki aged 25-59 years in 2003. There were 21,599 women and 5841 men participants. Three socio-economic position measures were used, namely three-level education, four-level occupational class and gross individual income quartiles. Main outcome measure was medically confirmed sickness absence spells of 4 days or longer. Inequality indices were calculated using Poisson regression analysis. High education, occupational class and individual income were all consistently associated with lower sickness absence rates among both women and men. After mutual adjustment, education and occupational class remained independent determinants of sickness absence. The association of individual income with sickness absence was practically explained by temporally preceding education and occupational class. Our results indicate that education and occupational class-rather than income-are strong determinants of sickness absence. Education, occupational class and income are complementary socio-economic position measures. To better inform sickness absence policy, future studies should aim to establish whether the observed socio-economic differences reflect broader differences in ill-health, lifestyle and working conditions.

Avoidable Sickness Absence in a Dutch Working Population

Sickness absence has an important impact on employers (e.g. reduced productivity, high costs) and employees (e.g. replacement, job loss). Therefore, we investigated possible reduction by exploring avoidable sickness absence. A questionnaire was filled out by 2,954 Dutch workers (internet panel of a marketing research company, 2005). We obtained data on self reported sickness absence (6.5 months), including the main reason for each sickness absence spell (4 health and 3 non-health reasons), self-reported work-relatedness of absence and workers' opinion on whether their absence could have been shorter or prevented, and on 12 listed factors that might have contributed to sickness absence. For each of these factors we calculated the avoidable absence fraction (AAF), analogous to the epidemiological population attributable risk. A total of 1,233 workers reported sickness absence. The absence rate was 4.46%. For 11% of the absence rate health was not the main reason. Yet, when non-health was reported as the main reason for absence, health still contributed in half the cases. 35% of the absence rate was mainly work-related. 15% of the workers mentioned that their sickness absence could have been shorter or prevented. The AAFs of contributory factors were 0.129 for home related factors, 0.136 for work-related factors and 0.101 for (occupational) health care and guidance factors. In total, the AAF showed that 21.5% of the absence rate can be considered possibly avoidable. According to the studied workers sickness absence rate can be reduced. In reducing the absence, one should not only consider factors from the home and work situation, but also from (occupational) health care.

A breath of fresh air

High rates of sickness absence among NHS staff put a strain on resources. One hospital has joined with its primary care trust to improve the health and fitness of its workforce and patients.

Explaining occupational class differences in sickness absence: results from middle-aged municipal employees

ObjectivesLow socioeconomic position is consistently associated with higher rates of sickness absence. We aimed to examine whether working conditions, health-related behaviours and family-related factors explain occupational class differences in medically...

Sickness absence: A gender-focused review

Women compared with men are generally considered to have higher sickness absence rates. Also determinants of sickness absent may differ between the sexes, a relevant area of knowledge for organizations that want to fine-tune particular measures to particular determinants. The present article offers a review of the literature regarding the relationships between sickness absence and gender. Various explanations mentioned in the literature are discussed using a classification derived from the Multi-Facet Gender and Health Model. Women compared to men seem indeed more frequently absent at work but this depends on countries, age – and professional groups, and seems restricted to short-term absence. Main conclusions with respect to future research concern the desirability of context-sensitive research and the usefulness of short-term versus long-term absenteeism as an outcome variable. Additionally, we recommend to further investigate the effects of organizational and psychosocial gender-related work characteristics, gender-bias in diagnostics and treatment, as well as gender differences in specific person-related factors interacting with gender differences in work-related daily life factors.

Per capita alcohol consumption and sickness absence in Norway

There is only one previous study addressing the relationship between population drinking and sickness absence. That study, based on Swedish time-series data, showed a statistically significant relationship between per capita alcohol consumption and the male sickness absence rate. Estimates suggested that a 1-l increase in consumption was associated with a 13% increase in sickness absence among men. In the present study, we aim at replicating and expanding the Swedish study on the basis of data for Norway. The outcome measure comprised annual data for Norway on registered sickness absence for manual employees covering the period 1957-2001. The unemployment rate was included as a control, as this factor may be correlated with alcohol as well as sickness absence. Alcohol consumption was gauged by sales of alcohol (total and beverage specific by beer, spirits and wine) per inhabitant 15 years and above. The data were analysed using the Box-Jenkins method for time-series analysis. The results suggested that a 1-l increase in total consumption was associated with a 13% increase in sickness absence among men (P < 0.05). This corresponds to an elasticity coefficient equal to 0.62. The alcohol effect was not significant for women. Unemployment was negatively associated with the outcome for men as well as for women (P < 0.05). In the beverage-specific analyses, spirits were statistically significant for men (P < 0.05), but not beer and wine. The present findings strengthen the conclusion from the Swedish study, that sickness absence may be added to the list of indicators of alcohol-related harm.

The effectiveness of vocationally oriented multidisciplinary intervention on sickness absence and early retirement among employees at risk: an observational study

Objective:To study the effect of a preventive vocationally oriented intervention on rates of sickness absence and disability pension in employees considered to be at risk of future work disability.Design:An observational...