Sickness Absence Spells Research Articles

Sick-leave trajectories among people sickness absent with stress-related diagnoses; cohort studies

Abstract Background Stress-related disorders are common sickness absence (SA) diagnoses in many Western countries. Knowledge of SA and disability pension (DP) patterns among people with such SA is needed. Thus, the aim was to identify future SADP trajectories among people with a new SA spell due to stress-related diagnosis and to examine sociodemographic and health-related factors associated with identified trajectories. Methods Using microdata from nationwide registers, we included all people living in Sweden with a new SA spell >14 days due to stress-related diagnoses (ICD-10 code F43) in 2011 (N = 32,417) or 2018 (N = 65,511), respectively. These two cohorts were followed prospectively for 13 months from the SA spell start, to identify trajectory groups of mean SA/DP days/month using group-based trajectory modeling. We used multinomial logistic regression to explore associations between sociodemographic and health-related predictors and trajectory membership. Results We identified the following SA/DP trajectories in both cohorts: steep drop (30.6% and 35.9% of all included in 2018 and 2011, respectively); fluctuating (8.7%, 11.2%); fast decrease (25.5%, 24.4%); medium decrease (18.1%, 13.1%); slow decrease (10.8%, 7.3%), and constant high (6.2%, 8.0%). Compared to the steep drop trajectory, individuals in the other trajectories were more likely women, older, and had prior SA/DP or secondary outpatient healthcare visits. Starting the SA spell full-time was the strongest predictor for the slow decrease and constant high trajectory, and previous SA or diagnosis of other mental disorders were predictors of the constant fluctuating and constant high trajectory. Conclusions The similarity of the identified trajectories in the two cohorts is a strength. The results reveal the diversity of future SA/DP in this patient group, indicating the importance of identifying patients at risk of long-term SA who might need further interventions early in the process. Key messages • In two population-wide cohorts with a new sickness absence (SA) spell with stress-related diagnoses, six trajectories of SA/disability pension days were identified during the 13-month follow-up. • Most of those in the cohorts had trajectories that ended with no SA/DP after 13 months, while two trajectories, including 15-19% of individuals, showed high or varying SA/DP days during the follow-up.

Sickness absence after work accidents and post-traumatic stress among white-collar workers in the retail and wholesale industry; a longitudinal Swedish cohort study

BackgroundMost studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers.AimTo examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry.MethodsA prospective population-based cohort study of all 192,077 such workers aged 18–67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012–2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit.Results35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly.ConclusionsAbout a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Does job stress mediate the risk of work disability due to common mental disorders among social workers compared with other health and social care, education, and non-human service professionals? A prospective cohort study of public sector employees in Finland.

This study aimed to investigate (i) the risk of work disability (>10-day sickness absence spell or disability pension) due to common mental disorders (CMD) among social workers compared with other health and social care, education, and non-human service professionals and (ii) whether the risk was mediated by job stress. A cohort of 16 306 public sector professionals in Finland was followed using survey data from baseline (2004 or if not available, 2008) on job stress [job strain or effort-reward imbalance (ERI)] and register data on work disability due to CMD from baseline through 2011. A Cox proportional hazards model was used to analyze the risk of work disability due to CMD between three occupation-pairs in a counterfactual setting, controlling for age, sex, job contract, body mass index, alcohol risk use, smoking, and physical inactivity. Social workers' job stress was at higher level only when compared to education professionals. Thus, the mediation hypothesis was analyzed comparing social workers to education professionals. Social workers had a higher risk of work disability due to CMD compared with education professionals [hazard ratio (HR) 2.08, 95% confidence interval (CI) 1.58-2.74]. This HR was partly mediated by job strain (24%) and ERI (12%). Social workers had a higher risk of work disability than non-human service professionals (HR 1.54, 95% CI 1.13-2.09), but not compared with other health and social care professionals. Job stress partly mediated the excess risk of work disability among social workers only in comparison with education professionals.

The Relationship between a Health-Promoting Lifestyle and Sickness Absence in a Healthcare Company

Introduction The health and wellbeing of healthcare workers is important. This study aims to determine if associations exist between the health promoting behaviour and sickness absence of people employed in a Middle-Eastern healthcare company over a 12 month period. Method A cross-sectional survey was sent to all employees (n=233); it measured sickness absence in spells and days and, ‘health promoting behaviour’ by use of the Health Promoting Lifestyle Profile II (HPLP II) which measured six subscales: Spiritual Growth, Interpersonal Relations, Nutrition, Physical Activity, Health Responsibility and Stress Management. Results The odds of high spells of sickness absence were 5 times greater in people with poor rather than good health promoting scores, after a post-hoc analysis (OR 5.3, p=0.0039, CI 1.7 to 16.6). Men had better physical activity scores than women (p<0.05). Job role was associated with sickness absence (p=0.003 for spells, 0.005 for days), with administrative staff having higher rates of sickness absence than clinical staff. Conclusion The results suggest that no specific health promoting behaviour was associated with sickness absence in this setting. However, the overall effect shows that higher HPLP II scores are correlated with lower sickness absence. Sickness absence may also be associated with job role.

Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland

ObjectivesThis study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to...

Provisions regarding organizational and social work environment and future sickness absence in Sweden

Abstract Background Sickness absence is high among healthcare employees in many European countries, including Sweden. In addition to physical workload, the importance of psychosocial work factors for this is emphasized. To promote a good psychosocial work environment, provisions on organisational and social work environment, mandatory to all work sectors, was launched in 2016 in Sweden. We compared sickness absence (SA) due to mental diagnoses two years before and two years after these provisions were introduced, among healthcare employees, employed by the municipality, the region, or private organisations. Methods Register microdata were used for analyses of all employees in the healthcare sector in Sweden in 2014 (N = 260,709) and in 2018 (N = 277,901). The odds ratios (OR) with 95% confidence intervals (CI) of new SA (in SA spells >14 days) and of long-term SA (>90 days) with a mental diagnosis in 2018 compared to 2014 were calculated, using logistic regression. Results The ORs of new SA and long-term SA with mental diagnoses among healthcare employees were somewhat higher in 2018 than in 2014 (OR = 1.14; 95% CI 1.11-1.17), (OR = 1.12; 1.07-1.17). The OR for the private sector for a new SA spell was 1.11; 1.02-1.19, and for the regional sector, OR 1.05; 1.01-1.08. The highest probability of long-term SA with mental diagnoses in 2018 compared to 2014 was found among employees in the municipal sector, OR 1.33, CI; 1.11-1.61, and in the private sector, OR 1.15, CI; 1.03-1.29. Discussion The mandatory provisions aim to promote good work environment and prevent risks of ill health due to organisational and social conditions at work. We observed a somewhat higher probability of SA with mental diagnoses two years after the provisions were introduced. SA due to mental diagnoses is influenced by many factors of which psychosocial work environment is only one part and maybe longer follow-ups are needed. Key messages • Sickness absence due to mental diagnoses among healthcare employees was somewhat higher two years after the introduction of an organisational and social work environment provision. • Many factors influence sickness absence with mental diagnoses; other factors and longer follow-ups are needed to gain knowledge on possible effects of the work environment provision.

Sickness absence after work injuries and post-traumatic stress among white-collar workers

Abstract Background There is very little knowledge about sickness absence (SA) and disability pension (DP) after work injuries and post-traumatic stress disorder (PTSD) among white collar workers. The aim was to examine diagnosis-specific SA and DP after healthcare due to a workplace injury and PTSD, respectively, among white-collar workers in the wholesale and retail industry in Sweden. Methods A prospective population-based cohort study of all 192,077 such white-collar workers (44% women) in Sweden in 2012, using linked microdata from three nationwide registers covering 2012-2016. We identified individuals who had specialised out- or inpatient healthcare due to a work injury (n = 1114) or to PTSD (n = 216) in the years 2012-2016. Their average number of net days of diagnosis-specific SA and DP was calculated for the 365 days before and 365 days after the healthcare visit. Results 64% of women and 45% of the men had at least one new SA spell during the 365 days after healthcare due to a work injury. On average, women had 14 SA/DP days the year before the injury and 31 days after; corresponding days for men were 9 and 21 days. SA days with fractures and with other injuries increased most, while SA days with mental diagnoses increased slightly. In the PTSD group, 80% of women and 65% of men had a new SA spell. Women's SA/DP days increased from 121 to 157 and men's from 112 to 174. SA with stress-related disorders and other mental diagnoses increased most, while DP with stress-related diagnoses and SA with musculoskeletal diagnoses increased slightly. Conclusions About half of those who had healthcare due to work injuries, and the majority of those who had PTSD, had new SA following the healthcare. SA due to diagnoses related to injury and mental diagnoses, respectively, increased most, however, SA/DP days due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP with different diagnoses after work injuries and PTSD. Key messages • About half of those who had specialised healthcare due to work injuries, and the majority of those who had PTSD, had new SA in the following 365 days. • Individuals with healthcare for PTSD had more SA/DP days both before and after their healthcare visit than those with work injuries, but individuals with work injuries had a larger increase.

Sick at work and future sickness absence - a prospective study of two measures of sickness presence

Abstract Background Sickness presence (SP), or going to work despite being ill, is a common way of practicing sickness absence (SA). However, its consequences for long-term SA are poorly understood, and there is no consensus on how to measure SP. This study aims to examine the consequences of SP on long-term sickness absence (>14 days) using two different measures. Methods Data from a Danish public human service organization were analyzed, with approximately 2400 employees answering questionnaires in November 2019, yielding a response rate of 50%. Information on SA, work environment, self-reported health, SP episodes, and sociodemographic information were included in negative binomial regression models. The outcome variable was prospective episodes of SA (>14 days) taken from the SA register of the organization. Two different ways of measuring SP were used: a traditional measure of overall SP frequency and a measure of going to work with specific symptoms (fever, cold, headache, musculoskeletal pain). Results Participants who reported SP frequency of more than 10 times during the last 6 months had a two-fold risk of long-term SA (IRR: 2.19 (95%CI 1.09-4.58)) in the follow-up period. This risk remained significant even after adjusting for work environment factors, sociodemographic factors, self-rated health, and spells of sickness absence in the previous year. Going to work with fever (IR: 1.43) or cold (IR: 1.48) was also associated with long-term SA in the follow-up period. Conclusions SP may negatively impact employees’ health status and increase long-term sickness absence. Health professionals should be aware of the negative consequences of focusing solely on reducing short-term sickness absence especially if they inadvertently encourage employees to substitute sickness presence for sickness absence. Key messages • Going to work despite having ill health is common but may have adverse health consequences and lead to long-term sickness absence. • Focusing narrowly on reducing short-term sickness absence might be a bad idea for public health. Employees might feel encouraged to go ill to work which could increase future sick leave.

Prior morbidity and sickness absence with Covid-19 among wholesale and retail blue-collar workers

Abstract Background Cancer, cardiovascular disease, hypertension, diabetes, chronic kidney disorders, chronic lung disorders, neurological disorders, obesity, immunocompromisation, and schizophrenia or bipolar disorders were found to be risk factors for severe Covid-19. The aim was to determine associations between having such diagnoses and future sickness absence (SA) due to Covid-19 or related diagnoses in 2020. Methods A prospective population-based cohort study of all 299,268 blue-collar workers (48% women) in Sweden in 2018, using linked microdata from four nationwide registers covering 2018-2020. People with any of the above diagnoses in 2018 or 2019 were identified using microdata from specialised in- and outpatient healthcare and prescribed drugs. Logistic regression was used to calculate the odds ratio (OR) and 95% confidence interval (CI) of a new SA spell >14 days due to diagnosed Covid-19 or one of the diagnoses used by the Social Insurance Agency for suspected Covid-19 in 2020, separately for each diagnosis group and a global estimate for all risk factors together, adjusted for sociodemographic characteristics. Results In total, 38,422 individuals had at least one of the diagnoses that was a risk factor for severe Covid-19. Of them, 284 individuals had SA due to Covid-19 or related diagnoses (0.7%) in 2020, while 1210 of those with no such risk factor for Covid-19 had SA due to Covid-19 or related diagnoses (0.5%). The adjusted OR of SA due to Covid-19 or related diagnoses was 1.37 (95% CI 1.20-1.56) for those who had any risk factors for severe Covid-19. The group of diagnoses with the highest adjusted OR for SA in Covid-19-related diagnoses was lung disease (2.23; 95% CI 1.93-2.56). Conclusions While only a few of those with prior morbidity that was a risk factor for severe Covid-19 had SA due to Covid-19 or related diagnoses in 2020, they had a higher risk than those without such prior morbidity. Key messages • Having prior morbidity with a diagnosis identified as a risk factor for severe Covid-19 was associated with a higher risk of having SA due to Covid-19 or related diagnoses in 2020. • Prior lung disease was the diagnosis group with the highest risk of SA due to Covid-19 or related diagnoses.

Psychosocial work factors and sickness absence among young Danish workers with a disease history

Abstract Background Young workers with a disease history may be more sensitive to adverse work environment, which could lead to increased rates of sickness absence (SA). This study investigates the association between psychosocial work factors and SA among young Danish workers with a history of somatic or mental disorders (N = 39,772). Methods We included young workers (aged 15-30) with a history of hospital-diagnosed somatic or mental disorders before labor market entry (between 2010 and 2018). SA spells of any length (≥1 day) were measured in registers and psychosocial work factors were estimated on the occupational level using job exposure matrices. We separately estimated adjusted rate ratios (RR) and 95% confidence intervals (95% CI) for women and men using Poisson regressions. Results Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Employment in occupations with high vs. low emotional demands showed the strongest association with a RR of 1.56 (95% CI: 1.48-1.65). Among men, employment in occupations with low decision authority showed the strongest association (1.40 [1.32-1.48]). In contrast, employment in occupations with high quantitative demands or high job strain was associated with lower rates of SA. Conclusions In a large nationwide sample of young workers with a history of somatic or mental disorders, we found several psychosocial work factors associated with SA at the job group level. Associations were overall similar to previously published results on all young workers. The results indicate that young workers with a history of somatic or mental disorders may not be more sensitive to adverse working conditions concerning the risk of SA and that preventive interventions, toward reducing SA, may have a similar impact regardless of disease history. Key messages • Several psychosocial working conditions were associated at the job group level with sickness absence in a nationwide sample of young workers with a disease history. • Associations were similar to previous results indicating that young workers with a disease history may not be more sensitive to adverse working conditions compared to the overall workforce.

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.

Identifying labour market pathways after a 30-day-long sickness absence –a three-year sequence analysis study in Finland

BackgroundReturn-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disability pension spells using sequence analysis among all-cause LTSA absentees.MethodsRegister data covered full-time and partial sickness allowance, rehabilitation, employment, unemployment benefits, and permanent and temporary disability pension (DP), retrieved for a 30% representative random sample of Finnish 18–59 years old persons with a LTSA in 2016 (N = 25,194). LTSA was defined as a ≥ 30-day-long full-time sickness absence spell. Eight mutually exclusive states were constructed for each person and for 36 months after the LTSA. Sequence analysis and clustering were used to identify groups with different labour market pathways. In addition, demographic, socioeconomic, and disability-related covariates of these clusters were examined using multinomial regressions.ResultsWe identified five clusters with emphases on the different states: (1) rapid RTW cluster (62% of the sample); (2) rapid unemployment cluster (9%); (3) DP after a prolonged sickness absence cluster (11%); (4) immediate or late rehabilitation cluster (6%); (5) other states cluster (6%). Persons with a rapid RTW (cluster 1) had a more advantaged background than other clusters, such as a higher frequency of employment and less chronic diseases before LTSA. Cluster 2 associated especially with pre-LTSA unemployment and lower pre-LTSA earnings. Cluster 3 was associated especially with having a chronic illness before LTSA. Those in cluster 4 were on average younger and had a higher educational level than others. Especially clusters 3 and 4 were associated with a LTSA based on mental disorders.ConclusionsAmong long-term sickness absentees, clear groups can be identified with both differing labour market pathways after LTSA and differing backgrounds. Lower socioeconomic background, pre-LTSA chronic diseases and LTSA caused by mental disorders increase the likelihood for pathways dominated by long-term unemployment, disability pensioning and rehabilitation rather than rapid RTW. LTSA based on a mental disorder can especially increase the likelihood for entering rehabilitation or disability pension.

Latent classes of unhealthy behaviours and their associations with subsequent sickness absence: a prospective register-linkage study among Finnish young and early midlife employees

ObjectivesUnhealthy behaviours are associated with increased sickness absence (SA), but few studies have considered person-oriented approach in these associations. Using latent class analysis, we examined clustering of unhealthy behaviours among...

Absence Due to Sickness Among Female Immigrants: Disadvantages Over the Career?

The extent to which and where immigrants’ health may deteriorate in the integration process is less understood. This study extends the current knowledge by focusing on sickness absence in Norway among female immigrants working within eight occupations where few formal skills are required. Administrative register data with a total sample of 261,291 native women and 9251 female refugees or families reunited are used to examine the native-immigrant gap in absence due to sickness during a 10-year period. The main findings are that female immigrants are less likely to have at least one sickness absence spell compared to natives, and that the native-immigrant gap in sickness absence was rather stabile when the number of years worked in these occupations was considered. This study shows that immigrants follow the same pattern as natives and suggests that the native-immigrant gap in absence due to health should be nuanced and focus more on why several years in these occupations increase the probability of sickness absence, independent of country of origin.

Psychosocial working conditions and sickness absence among younger employees in Denmark: a register-based cohort study using job exposure matrices.

Previous literature has established associations between psychosocial working conditions and sickness absence (SA), but only few studies have examined associations among younger employees. This study aimed to investigate associations between psychosocial working conditions and SA among employees, aged 15-30 years, who entered the labor market in Denmark between 2010 and 2018. We followed 301 185 younger employees in registers for on average 2.6 years. Using job exposure matrices, we assessed job insecurity, quantitative demands, decision authority, job strain, emotional demands, and work-related physical violence. Adjusted rate ratios of SA spells of any length were estimated for women and men separately with Poisson models. Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Being employed in occupations with high versus low emotional demands showed the strongest association with SA, with a rate ratio of 1.44 [95% confidence interval (CI) 1.41-1.47]. Among men, being employed in occupations with low decision authority showed the strongest association with SA (1.34, 95% CI 1.31-1.37), whereas occupations with high quantitative demands, high job strain, and high emotional demands were associated with lower rates of SA. We found that several psychosocial working conditions were associated with SA spells of any length. Associations with SA spells of any length resemble associations with long-term SA, suggesting that results from previous studies on long-term SA may be generalizable to all lengths of SA among younger employees.

A prognostic model for predicting the duration of 20,049 sickness absence spells due to shoulder lesions in a population-based cohort in Sweden.

Sickness absence duration for shoulder lesion patients is difficult to prognosticate, and scientific evidence for the sick-listing practice is lacking. Our objective was to develop a clinically implementable prediction model for the duration of a sickness absence spell due to shoulder lesions. All new sickness absence spells due to shoulder lesions (ICD-10-code: M75) issued in the period January 2010-June 2012 that were longer than 14 days were identified through the nationwide sickness absence insurance register. Information on predictors was linked from four other nationwide registers. Piecewise-constant hazards regression models were fitted to predict duration of sickness absence. The model was developed and validated using split sample validation. Variable selection was based on log-likelihood loss ranking when excluding a variable from the model. The model was evaluated using calibration plots and the c-statistic. 20 049 sickness absence spells were identified, of which 34% lasted >90 days. Predictors included in the model were age, sex, geographical region, occupational status, educational level, birth country, specialized healthcare at start of the spell, number of sickness absence days in the last 12 months, and specialized healthcare the last 12 months, before start date of the index sickness absence spell. The model was satisfactorily specified and calibrated. Overall c-statistic was 0.54 (95% CI 0.53-0.55). C-statistic for predicting durations >90, >180, and >365 days was 0.61, 0.66, and 0.74, respectively. The model can be used to predict the duration of sickness absence due to shoulder lesions. Covariates had limited predictive power but could discriminate the very long sickness absence spells from the rest.

Trajectories of part-time work and sickness absence among shift working healthcare employees

Abstract Background Healthcare systems are facing major challenges due to population ageing, increased need for care, and economic challenges combined with staff shortage. The existing need for longer work careers combined with increasing turnover rates in healthcare highlights the need to understand working hours in association with work capacity and sustainable work careers. We aimed to investigate the concurrent changes in part-time work and sickness absence (SA) among healthcare employees without any SA spell >14 days at baseline. Methods Annual working hour and SA data from 23 hospital districts and cities in Finland for 2008-2019 (172 922 employees with at least one work shift in any year). The sample was restricted to 20274 employees with ≤31 work shifts/year in 3 consequent years during the follow-up and without any SA spell >14 days at baseline in 2008. Part-time work/year (yes/no), SA months/year, and nightwork/year (% of nightwork of all shifts) as time varying covariate were used in the group-based trajectory models examining the concurrent changes. Models for age groups (in 2008 and categorized into < 25 years of age, ≥25 and <40 years, ≥40 and <55 years, and >55 years) will be considered later. Results A five-trajectory solution identified groups for “stable full-time work without SA” (56.8%), “increasing part-time work and stable very low SA” (13.5%), “slight increase both in part-time work and SA” (16.5%), “steep increase in part-time work and reversed low U-shape in SA months” (5.0%), and “stable part-time work and low SA” (8.2%) across 2009-2019. Conclusions These initial findings indicate that while most employees work full-time without SA, those who transfer from working full-time to part-time during follow-up from 2009 to 2019 seem to have low SA. Thus, part-time work may promote work capacity, and accompanied by part-time work disability benefits, offer a tool for employers to support sustainable working life and to keep older employees at work. Key messages

Prior sick leave with mental or somatic diagnoses and being in work in ages 66–71; a Swedish cohort

Abstract Background As longevity and retirement ages are increasing, knowledge is needed on factors hindering extended working lives. The aim of this study was to explore how sickness absence (SA) and disability pension (DP) due to mental and/or somatic diagnoses before age 65 were associated with being in paid work when aged 66-71. Methods A 6-year prospective population-based cohort study of all 98,551 people (48% women) in Sweden who turned 65 years in 2010 (baseline year) and had been in paid work at any point when aged 60-64. Microdata from nationwide registers were used. Exposure variables were SA (spells >14 days) and/or DP in 2005-2009, and the outcome variable was paid work at any point in 2011-2016. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI) for associations between exposures and outcome, controlling for sociodemographic factors in 2010, stratified by sex. Results Most women (56.0%) and men (66.3%) had no SA or DP when aged 60-64. Of the women, 42.7% and of the men 53.3% were in paid work after the age of 65. Those with SA due to mental diagnoses had lower OR of being in paid work (women 0.76; 95% CI: 0.69-0.84; men 0.74; 0.65-0.84). This association was weaker for SA due to somatic diagnoses (women 0.87; 0.84-0.91; men 0.92; 0.89-0.96). Having had SA due to both mental and somatic diagnoses was associated with lower OR for men (0.77; 0.65-0.91) but not women (0.98; 0.88-1.09). Full- or part-time DP had the strongest association with not being in paid work regardless of diagnosis group and sex (e.g., women mental DP 0.39; 0.34-0.45; women somatic DP 0.38; 0.35-0.41; men mental DP 0.36; 0.29-0.43; men somatic DP 0.35; 0.32-0.38). Conclusions SA due to mental diagnoses had a stronger association with not being in paid work after age 65 than SA due to somatic diagnoses. The results highlight the importance of identifying factors that hinder older workers with mental disorders to extend their working lives. Key messages

Clustering of unhealthy behaviours and subsequent sickness absence among Finnish municipal employees

Abstract Background Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have explored these associations using person-oriented approach. We aimed to identify latent classes of unhealthy behaviours among female and male employees and examined their associations with subsequent SA. Methods Health behaviours (leisure-time physical activity, sedentary behaviour, fruit and vegetable [F&V] consumption, sleep, binge drinking, and use of tobacco products) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19-39-year-old employees of the City of Helsinki, Finland. The questionnaire data were linked to employer's SA register. Latent class analysis was used to identify underlying profiles of unhealthy behaviours and negative binomial regression was used to examine their associations with subsequent SA (≤7 days, >7 days, and all lengths) among 3228 women and 771 men. The mean follow-up time was 2.1 years. Results Among women, we identified 3 latent classes: 1) healthy behaviours (81% of women), 2) binge drinking and tobacco use (12%), and 3) inadequate F&V consumption and insufficient sleep (7%). Classes 2 and 3 showed increased rates for subsequent SA compared to class 1, regardless of the length of SA spells (age-adjusted rate ratios [RR] 1.37-1.42 and 1.35-1.64, respectively). Among men, we identified 3 latent classes: 1) healthy behaviours (51% of men), 2) binge drinking and tobacco use (19%), and 3) inadequate F&V consumption, binge drinking and tobacco use (30%). While classes 1 and 2 were not different in terms of subsequent SA, class 3 had increased rates of subsequent, particularly short-term SA (RR 1.24, 95% CI 1.03-1.48). Conclusions Preventive actions should consider simultaneously several unhealthy behaviours while aiming to reduce employees’ SA. These actions might benefit from regarding potential gender differences in the clustering of unhealthy behaviours and their associations with SA. Key messages • Preventive actions to reduce sickness absence should consider clustering of unhealthy behaviours among employees. • Potential gender differences need to be regarded in these actions.