Sickness Absence Trajectories Research Articles

Determinants of long-term sickness absence trajectories among 19–39-year-old employees with pain

Abstract Background Previous studies have shown higher long-term sickness absence (LTSA) rates among employees with pain as compared to those not reporting pain. We examined distinct developmental patterns in LTSA (≥10 consecutive working days) among young and early midlife employees with pain at baseline, and factors associated with LTSA trajectories. Methods The study population consisted of 19-39-year-old employees (n = 1685) of the City of Helsinki who reported current pain at baseline in 2017. Data on all-cause LTSA days through March 2020 were collected from the Social Insurance Institution of Finland. Group-based trajectory modelling was used to identify distinct all-cause LTSA trajectories. Multinomial logistic regression was used to examine associations of pain characteristics, lifestyle- and occupational factors with trajectory group membership. Results Three distinct LTSA-trajectory groups were identified; No LTSA (74%), Decreasing (18%), and Increasing (8%). Compared to the No LTSA trajectory, employees in the Decreasing trajectory were more likely to have chronic (OR 1.34, 95% CI 1.04-1.73) or multisite (OR 1.81, 95% CI 1.36-2.41) pain, smoke (OR 1.55, 95% CI 1.18-2.03), have obesity (OR 1.70, 95% CI 1.21-2.38), manual or routine non-manual occupation (OR 1.87, 95% CI 1.31-2.67) and high physical workload (OR 1.47, 95% CI 1.14-1.90), after adjusting for age and gender. Predictors of the Increasing trajectory were not identified. Conclusions Distinct LTSA-trajectories were identified among young and early midlife employees with pain, of whom a majority had no LTSA during follow-up. Chronic and multisite pain, unhealthy lifestyle, lower occupational class, and higher physical workload are related to a pattern with more LTSA. Future intervention studies could examine opportunities to prevent LTSA through supporting younger employees who work with pain and have these risk factors. Key messages • Distinct trajectories of LTSA were identified among younger employees with pain, of whom most had no LTSA. Pain characteristics, lifestyle and occupational factors predicted trajectory membership. • Future intervention studies could examine opportunities to prevent LTSA through support to employees who work with pain and have pain-, lifestyle- and occupation related risk factors of LTSA.

Long-term sickness absence trajectories among ageing municipal employees – the contribution of social and health-related factors

BackgroundThe ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA.MethodsData comprised of municipal employees of the city of Helsinki aged 50–60 years during 2004–2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004–2018. All-cause and diagnosis-specific (mental disorder– and musculoskeletal disease–related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals).ResultsA model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models.ConclusionsMost ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Longitudinal trajectories of sickness absence among young adults with a history of depression and anxiety symptoms in Sweden

BackgroundDepression and anxiety are associated with increased risk of sickness absence (SA), yet the developmental patterns of SA remain unclear. We aimed to identify trajectories of SA in young adults with depression and/or anxiety, accounting for sociodemographic and occupational factors. MethodsLongitudinal study of 1445 twin individuals with elevated depressive/anxiety symptoms in late adolescence or young adulthood (age range: 19–30), assessed in Swedish surveys completed in 2005. Through linkage to nationwide registries, individuals were prospectively followed from 2006 to 2018. The outcome included consecutive annual days of SA, which were analyzed using group-based trajectory modeling. Multinomial logistic regression estimating odds ratios (OR) with 95 % confidence intervals (CI) was used to examine associations of age, sex, and educational level with the resulting SA trajectories. ResultsFour distinct SA trajectories were identified in the total sample: ‘high-increasing’ (6 %), ‘low-increasing’ (12 %), ‘high-decreasing’ (13 %), and ‘low-constant’ (69 %). Increasing age was associated with higher odds of belonging to the low-increasing trajectory (OR = 1.07, 95 % CI = 1.02–1.12). Women had higher odds of belonging to the low-increasing trajectory (OR = 1.67, 95 % CI = 1.10–2.53), compared with men. Higher education was associated with lower odds of belonging to high-increasing (OR = 0.34, 95 % CI = 0.22–0.54) and high-decreasing (OR = 0.59, 95 % CI = 0.43–0.81) trajectories, compared with lower education. Few differences were observed in analyses stratified by occupational sector. LimitationsInformation on potential confounders (e.g., psychiatric comorbidity, work-environment factors) was not available. ConclusionsAmong young adults with prior depression/anxiety, close to every fifth showed rising SA trajectories over time. This calls for targeted strategies to improve public mental health already at young ages.

Identification and Characterisation of Trajectories of Sickness Absence Due to Musculoskeletal Pain: A 1-Year Population-based Study

Purpose This study aimed to identify trajectories of sickness absence in workers on sick leave due to musculoskeletal disorders and explore the association between these trajectories and established prognostic factors for sickness absence. Methods We conducted a prospective cohort study of 549 workers (56% women, aged 18–67 years) on sick leave due to musculoskeletal disorders in Norway in 2018–2019. Sickness absence data were collected from the Norwegian sick leave registry and prognostic factors via self-reported baseline questionnaires. We used group-based trajectory modelling to define the different trajectories of sickness absence spanning a 1-year period. Multivariable multinomial logistic regression was used to estimate odds ratios and 95% confidence intervals for prognostic factors associated with the identified trajectory groups. Results We identified six distinct trajectories of sickness absence over 1 year: ‘fast decrease’ (27% of the cohort): ‘moderate decrease’ (22%); ‘slow decrease’ (12%); ‘u-shape’ (7%); ‘persistent moderate’ (13%); and ‘persistent high’ (18%). Prognostic factors, such as previous sickness absence days, return-to-work expectancy, workability, multisite pain, and health scores, differentiated between the sickness absence trajectories (all P < 0.05). Negative return-to-work expectancy was associated with the three trajectory groups with the highest number of sickness absence days (‘slow decrease’, ‘persistent moderate’, and ‘persistent high’). Conclusions This is the first study to explore the association of return-to-work expectancy with trajectories of sickness absence. Our findings highlight different patterns of sickness absence and the complex range of prognostic factors. These findings have implications for secondary and tertiary prevention strategies for work absence in workers with musculoskeletal disorders.

Ausencia por enfermedad, condiciones médicas y de trabajo durante el embarazo en una cohorte de profesionales sanitarias

To assess the association between sickness absence (SA) trajectories by medical diagnoses and exposure to occupational risk factors during pregnancy. Methods: SA trajectories were identified in a cohort of 367 pregnant workers from a healthcare institution (period 2010-2014), based on most frequent diagnosis using sequence analysis. Trajectory 1 included SA episodes due mainly to musculoskeletal disorders (58.86%), trajectory 2 included SA episodes due to pregnancy-related disorders (25.07%) and trajectory 3 included absences mainly covered by pregnancy-related occupational risk benefits (POR) and few SA episodes (16.08%). Exposure to occupational risk factors was assessed by experts and their association with trajectories was analysed using logistic regression. Relative risks (RR) and their 95% confidence intervals (95%CI) were adjusted for age, type of contract and work shift. Trajectory 1 was negatively associated with exposure to safety and ergonomic risks (RR=0.56, 95%CI=0.35-0.90; RR=0.50, 95%CI=0.33-0.77, respectively) and with the highest global risk index (RR=0.68, 95%CI=0.49-0.96). Trajectory 3 was associated with safety and ergonomic risks (RR=2.75, 95%CI=1.59-4.75; RR=3.64, 95%CI=2.18-6.06, respectively) and with the highest global risk index (RR=2.69, 95%CI=1.43-5.01). Nursing aides and nurses had a higher probability of belonging to trajectory 3 (RR 5.58, 95%CI=2.09-14.95 and RR 5.00, 95%CI 2.18-6.06, respectively). Pregnancy-related and musculoskeletal disorders are the most frequent sickness absence diagnosis during pregnancy. Low levels of occupational risk factors exposure were related to absences from work covered mainly by sickness absence. Current social benefits seem to be used as a complementary way to balance work and health during pregnancy.

Process of Work Disability: From Determinants of Sickness Absence Trajectories to Disability Retirement in A Long-Term Follow-Up of Municipal Employees.

Work disability may originate early during work history and involve sickness absences (SA) and eventually permanent disability. We studied this process over 15 years. Questionnaire data collected in 1981 on health, working conditions, and lifestyle of Finnish municipal employees aged 44–58 years (n = 6257) were linked with registers on SA (≥10 workdays), disability pension, and death from the period 1986–1995. Trajectory analysis was used to assess development in SA (days/year) over 5 years (1981–1985). We analyzed determinants of the trajectories with multinomial regression, while trajectory membership was used as a predictor of disability pension (DP) during the subsequent 10 years in survival analysis. Three SA trajectories emerged: increasing (women: 6.8%; men: 10.2%), moderate (21.2%; 22.7%), and low. In a mutually adjusted model, the increasing trajectory in women was associated with baseline musculoskeletal (MSD), mental and respiratory disorders, injuries, obesity, sleep problems, and low exercise (effect sizes OR > 2), and in men with MSD, sleep problems, smoking, low exercise, and non-satisfaction with management. The moderate trajectory associated with MSD, ‘other somatic disorders’, sleep problems, and awkward work postures in both genders; in women, also overweight, cardiovascular and respiratory morbidity, and (inversely) knowledge-intensive work, and in men, smoking and mental disorders were thus associated. Ten-year risks of DP contrasting increasing vs. low SA were more than 10-fold in both genders and contrasting moderate vs. low SA 3-fold in women and 2-fold in men. These findings emphasize the need for early identification of workers with short-term problems of work ability and interventions regarding lifestyle, health, and working conditions, to help prevent permanent disability.

Association between early working life patterns, in publicly and privately owned companies, and the course of future sickness absence due to mental disorders: a cohort study in Catalonia (Spain)

ObjectivesTo assess the relationship between early working life patterns, at privately and publicly held companies, and the course of sickness absence (SA) due to mental disorders.MethodsCohort study of workers aged...

Sickness absence trajectories following labour market participation patterns: a cohort study in Catalonia (Spain), 2012\u20132014

BackgroundPrevious studies have focused on the relationship between employment pathways and health-related outcomes based on cross-sectional or longitudinal approaches. However, little is known about the cumulative effects of employment status mobility on sickness absence (SA) over time. The aim of the present study was to examine the association between prior labour market participation (LMP) patterns and SA trajectories from a life-course perspective.MethodsThis cohort study was based on a sample of 11,968 salaried workers living in Catalonia and affiliated with the Spanish Social Security system, who accumulated more than 15 days on SA in at least one quarter during 2012–2014. Individuals were grouped into three different working life stages: early (18–25 years), middle (26–35 years), and late (36–45 years). To identify LMP patterns, we applied sequence analysis and cluster analysis (2002–2011), and we used latent class growth modelling to identify SA trajectories (2012–2014). Finally, we applied multinomial logistic regression models to assess the relationship between LMP patterns and SA trajectories.ResultsThe analyses yielded six LMP patterns: stable employment (value range: 63–81%), increasing employment (5–22%), without long-term coverage (7–8%), decreasing employment (4–10%), fluctuant employment (13–14%), and steeply decreasing employment (7–9%). We also identified four SA trajectories: low stable (83–88%), decreasing (5–9%), increasing (5–11%), and high stable (7–16%). However, the only significant association we identified for LMP patterns and SA trajectories was among young men, for whom an increasing employment pattern was significantly associated with a lower risk for increased days on SA (adjusted odds ratio: 0.21; 95% confidence interval: 0.05–0.96).ConclusionsSA trajectories are generally not related to prior 10-year LMP patterns at any stage of working life. To disentangle this relationship, future research might benefit from considering working life transitions with a quality-of-work approach framed with contextual factors closer to the SA course.

Sickness absence trajectories following labour market participation patterns in Catalonia, 2012-2014

Abstract Background Working life is characterized by transitions between different employment status which could affect future health status. Previous studies on sickness absence (SA) have focused on risk factors in the workplace; however, there is scarce evidence regarding labour market participation (LMP) patterns. The aim of this study is to examine the association between prior LMP patterns and the course of SA. Methods Cohort study based on a sample of 11,968 salaried workers affiliated with the Spanish Social Security system, living in Catalonia, who accumulated more than 15 days on SA at least in one quarter during 2012-2014, from three working life cohorts according to the working life stage in 2002: early (18-25 years), middle (26-35 years) and late (36-45 years). Sequence analysis was used to identify LMP patterns (2002-2011). Latent class growth analysis was applied to identify SA trajectories (2012-2014). Finally, crude and adjusted odds ratios (aOR) were estimated using multinomial logistic regression models. Results Overall, four SA trajectories were identified: low stable (83%-88% of the workers), decreasing (5%-9%), increasing (5%-11%) and high stable (7%-16%) accumulated days on SA, for men and women. Similarly, seven LMP patterns were obtained: stable employment (63%-81%), increasing employment (5%-22%), delayed employment (7%-8%), decreasing employment (4%-10%), varying employment (13%-14%), steeply decreasing employment (9%), and steeply labour market exit (8%). No significant associations were observed among LMP patterns and SA trajectories, except for young men, where an increasing employment pattern was significantly associated with a lower risk to increase days on SA over time (aOR: 0.21 [95% CI: 0.04-0.96]). Conclusions A prior 10 years of LMP pattern does not seem to show an effect on the course of SA. A closer working life to the SA course could be considered to assess this relationship. Funding: Grants FIS PI17/00220 and PI14/00057 Key messages A longitudinally approach is warranted to evaluate the relationship between working life and sickness absence. Extended prior working lives are not related to the course of future sickness absence.

Work-Related Exposures and Sickness Absence Trajectories: A Nationally Representative Follow-up Study among Finnish Working-Aged People.

The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30–59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002–2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43–0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with ≥4 physical workload factors (OR 2.71; 95% CI 1.99–3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors.

Identifying return-to-work trajectories using sequence analysis in a cohort of workers with work-related musculoskeletal disorders

Objectives This study aimed to identify return-to-work (RTW) trajectories among workers with work-related musculoskeletal disorders (MSD) and examine the associations between different MSD and these RTW trajectories. Methods We used administrative workers' compensation data to identify accepted MSD lost-time claims with an injury date between 2010-2012 in British Columbia, Canada. Cox regression analyses were used to investigate differences in time to RTW between MSD. Validated day-to-day calendar measures of four RTW states (sickness absence, modified RTW, RTW, and non-RTW) were grouped into RTW trajectories spanning a one-year period using sequence analysis. RTW trajectories were clustered using decision rules that identified a shared trajectory structure. Poisson regression with robust standard errors was used to estimate relative risk ratios (RR) with 95% confidence intervals (CI) between MSD and RTW trajectory clusters. Results In a cohort of 81 062 claims, 2132 unique RTW trajectories were identified and clustered into nine RTW trajectory clusters. Half of the workers sustainably returned to work within one month. Workers with back strains were most likely to have trajectories characterized by early sustained RTW, while workers with fractures or dislocations were more likely to have prolonged sickness absence trajectories (RR 4.9-9.9) or non-RTW trajectories (RR 1.4-7.6). Conclusion This is the first study that has characterized different types of RTW trajectories of workers with MSD using sequence analysis. The application of sequence analysis and the identification of RTW trajectories yielded a number of key insights not found using conventional cox regression analysis.

Pain in multiple sites and sickness absence trajectories: A prospective study among Finns

We studied the number of musculoskeletal pain sites as a predictor of sickness absence during a 7-year follow-up among a nationally representative sample (the Health 2000 survey) of occupationally active Finns 30 to 55years of age (3420 subjects who did not retire or die during the follow-up). Baseline data (questionnaire, interview, clinical examination by a physician) were gathered in 2000 to 2001 and linked with information from national registers on annual compensated sickness absence periods (⩾10workdays) covering the years 2002 to 2008. Pain during the preceding month in 18 body locations was inquired and combined into 4 sites (neck, upper limbs, low back, lower limbs). Demographic factors, BMI, smoking, leisure-time physical activity, sleep disorders, physical and psychosocial workload, and chronic diseases were assessed. Four distinct sickness absence trajectories emerged, labeled as Low (59% of the subjects), Ascending (21%), Mixed (11%), and High (9%). In multinomial logistic regression, the odds ratios (ORs) for belonging to the High vs. the Low trajectory increased with the number of pain sites, being 2.1 for single-site pain, 2.6 for 2 pain sites, 2.9 for 3 pain sites, and 4.1 for 4 pain sites, after adjustment for chronic diseases, demographic and lifestyle factors, and workload. The confidence intervals of the ORs did not include unity. The adjusted ORs for belonging to the Ascending trajectory were 1.1, 1.3, 1.7, and 1.7, respectively. As the number of pain sites was a strong independent predictor of work absenteeism, early screening of workers with multisite pain and interventions to support work ability seem warranted.