Anne Chevalier

Diagnosis-specific sickness absence and all-cause mortality in the GAZEL study

Background: This study aims to examine diagnosis-specific sickness absence as a risk marker for all-cause mortality. Methods: Prospective occupational cohort (the GAZEL study). Medically certified sickness absence spells >7 days for 15 diagnostic categories, 1990–1992, were examined in relation to all-cause mortality, January 1993–February 2007. The reference group for each diagnostic category was participants with no spell >7 days for that diagnosis. The participants were French public utility workers (5271 women and 13 964 men) aged 37–51 years in 1990, forming the GAZEL study. Over the follow-up period, there were 144 deaths in women and 758 in men. Results: 7875 employees (41.0%) had at least one spell of sickness absence >7 days over the 3-year period. The commonest diagnoses were mental disorders, musculoskeletal diseases, respiratory diseases and external causes in both sexes; genitourinary diseases in women, and digestive and circulatory diseases in men. Of these common diagnoses, mental disorders in women, hazard ratio (95% confidence intervals) 1.24 (1.1 to 1.4), and mental disorders 1.35 (1.3 to 1.5), digestive diseases 1.29 (1.1 to 1.6) and circulatory diseases 1.35 (1.2 to 1.6) in men were associated with mortality after adjustment for age, employment grade and sickness absence in all other diagnostic categories. Conclusions: Employees with medically certified absence spells of 1 week or more over a 3-year period had a 60% excess risk of early death. In women and men this excess risk was associated with some of the commonest diagnoses of sickness absence, in particular mental disorders. Sickness absence for mental disorders may be a useful early indicator of groups at increased risk of fatal disease.

Sickness absence at the French National Electric and Gas Company.

The certified sickness absence of workers in the French National Electric and Gas Company was studied for 12 months and has been described according to the demographic and occupational characteristics of the employees. The results showed that the principal factors affecting absence are sex, job, and salary. The high percentage of absent women was explained by neither the type of occupation nor family status. Respiratory diseases, accidents, and musculoskeletal and psychiatric disorders were the leading diagnostic categories. Indices of severity, duration, and frequency were calculated and compared between groups. The duration of absence increased with the severity of the medical cause of absence and with the patients age.

Sickness absence as a prognostic marker for common chronic conditions: analysis of mortality in the GAZEL study

Objectives: To determine whether sickness absence is a prognostic marker in terms of mortality among people with common chronic conditions. Methods: Prospective occupational cohort study of 13 077 men and 4871 women aged 37–51 from the National Gas and Electricity Company, France. Records of physician-certified sickness absences over a 3-year period were obtained from employers’ registers. Chronic conditions were assessed in annual surveys over the same period. The main outcome measure was all-cause mortality (803 deaths, mean follow-up after assessment of sickness absence: 13.9 years). Results: In Cox proportional hazard models adjusted for age, sex, socioeconomic position and co-morbidity, >28 annual sickness-absence days versus no absence days was associated with an excess mortality risk among those with cancer (hazard ratio 5.4, 95% CI 2.2 to 13.1), depression (1.7, 1.1 to 2.8), chronic bronchitis or asthma (2.7, 1.6 to 4.6) and hypertension (1.6, 1.0 to 2.6). The corresponding hazard ratios for more than five long (>14 days) sickness-absence episodes per 10 person-years versus no such episodes were 5.4 (2.2 to 13.1), 1.8 (1.3 to 2.7), 2.0 (1.3 to 3.2) and 1.8 (1.2 to 2.7), respectively. Areas under receiver operating characteristics curves for these absence measures varied between 0.56 and 0.73, indicating the potential of these measures to distinguish groups at high risk of mortality. The findings were consistent across sex, age and socioeconomic groups and in those with and without co-morbid conditions. Conclusion: Data on sickness absence may provide useful prognostic information for common chronic conditions at the population level.

Surveillance of fatal occupational injuries in France: 2002–2004

BACKGROUND Insufficient use is made of available information about workplace and commuting accidents covered by social insurance workers compensation funds in France. We sought to determine whether these data could be used to calculate national indicators for surveillance of fatal occupational injuries for 2002-2004. METHODS We calculated the number of deaths, mortality rate, and years of potential life lost from workplace and commuting accidents (by sex, age, economic activity, and cause of accident) for employees by collecting data from eight social insurance funds in France. The number of deaths, the mortality rates, and the attributable fraction of accidental deaths due to work were estimated for both employees and self-employed workers. RESULTS The mean annual number of employee deaths from workplace and commuting accidents reached 1,330 in 2002-2004. The mortality rate from workplace accidents (6.0 per 100,000) increased with age among men and was especially high in three sectors: agriculture-forestry-fishing, transportation, and construction.Overall, for employees and the self-employed combined, the mean annual number of deaths from workplace and commuting accidents was estimated at 1,557 (95% CI: 1,478-1,640). The attributable fraction of accidental deaths due to work for those aged 15-59 years was estimated at almost 20% among men. CONCLUSIONS Despite data limitations, it was possible to calculate previously unknown national indicators of fatal workplace and commuting accidents and to compare them with other work-related health problems. These results are consistent with those observed in comparable industrialized countries.

Estimation of under-reporting of work-related musculoskeletal diseases (MSDs) in France: comparison between data from compensated occupational diseases system and data from epidemiological surveillance system of non-compensated work-related diseases (WRD)

Objectives In industrial countries, studies suggest under-reporting of occupational diseases, particularly for MSDs. In France, the financial compensation of occupational disease relies on “tables”, based on presumption of causality, which define the necessary and sufficient conditions. WRD are all the non-compensated diseases from occupational origin. They were registered via an epidemiological surveillance system, based on a network of volunteer occupational physicians, in 7 regions in 2007. The aim of this study was to evaluate under-reporting of 3 localisations of MSDs: shoulder, hand-wrist-fingers (including carpal tunnel syndrome) and rachis by comparing data from these two systems. Methods Agriculture, education, health and administration were excluded because they were insured by another special compensation system. For each localisation, an indicator of under-reporting (I1) was defined as following: frequency of non-compensated MSDs corresponding to a compensation system table / frequency of compensated MSDs. I1 was analysed by gender, age, business activity sectors and region. Results I1 was equal to 4 for shoulder, 7 for hand-wrist-fingers and 6 for rachis, with variations according to gender and age. I1 was lower in the manufacturing industries for hand-wrist-fingers. According to region, I1 varied from 8 to 14 for hand-wrist-fingers, from 1 to 9 for shoulder and 0 to 15 for rachis. Conclusions The indicator quantification is crude because external factors not only diagnosis had to be considered from reporting to compensation. However, this study for the first time provided an estimation of under-reporting of 3 localisations of MSDs in France. A similar work about under-compensation is in progress.