Margaretha Voss

Physical, psychosocial, and organisational factors relative to sickness absence: a study based on Sweden Post

OBJECTIVE To analyse incidence of sickness for women and men relative to potential aetiological factors at work—physical, psychosocial, and organisational. METHODS The study group comprised 1557 female and 1913 male employees of Sweden Post. Sickness absence was measured by incidence of sickness (sick leave events and person-days at risk). Information on explanatory factors was obtained by a postal questionnaire, and incidence of sickness was based on administrative files of the company. RESULTS Complaints about heavy lifting and monotonous movements were associated with increased risk of high incidence of sickness among both women and men. For heavy lifting, an odds ratio (OR) of 1.70 (95% confidence interval (95% CI) 1.22 to 2.39) among women, and OR 1.70 (1.20 to 2.41) among men was found. For monotonous movements the risk estimates were OR 1.42 (1.03 to 1.97) and OR 1.45 (1.08 to 1.95) for women and men, respectively. Working instead of taking sick leave when ill, was more prevalent in the group with a high incidence of sickness (OR 1.74 (1.30 to 2.33) for women, OR 1.60 (1.22 to 2.10) for men). Overtime work of more than 50 hours a year was linked with low incidence of sickness for women and men. Among women, 16% reported bullying at the workplace, which was linked with a doubled risk of high incidence of sickness (OR 1.91 (1.31 to 2.77)). For men, the strongest association was found for those reporting anxiety about reorganisation of the workplace (OR 1.93 (1.34 to 2.77)). CONCLUSIONS Certain physical, psychosocial, and organisational factors were important determinants of incidence of sickness, independently of each other. Some of the associations were sex specific.

Comparisons of self-reported and register data on sickness absence among public employees in Sweden

Aim: Self-reported assessments of sickness absence are often performed in epidemiological studies. The objective of this study was to compare the number of sick-leave days according to self-reported data over 12 months with data from the employer’s register for the same period. An additional aim was to ascertain whether the self-reported information and the recorded data would show equivalent associations with self-reported general health. Methods: The study was based on a cohort of 4869 municipal employees in Sweden, about 80% women, who answered a questionnaire in 2001–2. The responses provided by the employees included information on number of sick-leave days and self-rated health. Data on sick-leave days, occupation and age were derived from the employers’ computerised registers. The questionnaire information on sick-leave days was compared with the corresponding information retrieved from the employer register by means of calculating sensitivity and specificity, using the employers’ data as the “gold standard”. Results: The annual number of sick-leave days was lower according to the self-reported information than to the register data. For women the agreement between the two sickness absence measures for no sick-leave days, 1–7 days and ≥28 days were 74%, 72% and 67%, respectively. The sensitivity of questionnaire versus register information regarding any self-reported sick-leave day was 91% and the specificity was 74%. Sensitivity and specificity for sickness absence ⩾28 days were 67% and 98%, respectively. The results for men were similar to those for women. Self-reported and recorded sickness absence were both associated with self-rated health. The odds ratios were 7.27 and 8.25, for subjects with ≥28 recorded and self-reported number of sick-leave days respectively, compared to subjects with no sickness absence. Conclusions: Good agreement was found between self-reported and register information on sickness absence. Self-reported data on sickness absence may be useful in common epidemiological applications.

Unemployment and Early Cause-Specific Mortality: A Study Based on the Swedish Twin Registry

OBJECTIVES We investigated the association between unemployment and early cause-specific mortality to determine whether the relationship was modified by other risk indicators. METHODS Female and male twins (n=20632) were followed with regard to mortality from 1973 through 1996. Questionnaire data from 1973 were used to obtain information on experience of unemployment and on social, behavioral, health, and personality characteristics. RESULTS Unemployment was associated with an increased risk of suicide and death from undetermined causes. Low education, personality characteristics, use of sleeping pills or tranquilizers, and serious or long-lasting illness tended to strengthen the association between unemployment and early mortality. CONCLUSIONS An increased risk of death from external causes implies a need for support for those experiencing unemployment, particularly susceptible individuals.

Long-term sick-listing among women in the public sector and its associations with age, social situation, lifestyle, and work factors: A three-year follow-up study

Background: Since 1997 the number of long-term sick-listed people in Sweden has increased dramatically, especially among women employed in the public sector. Aims: The aim of this study was to investigate associations between age, social situation, lifestyle, work factors, and long-term sick-listing (≥28 days), regardless of diagnosis, during a period of three years among women employed in the public sector. Methods: Exposure information at baseline was recorded by a questionnaire. All new spells of sick-listing ≥28 days were consecutively reported from the employer for three years from baseline. In total 6,246 women from the public sector in Sweden answered the questionnaire (85% response rate); 5,224 were classified as having good or rather good health for working and were included. Of these, 918 persons had spells of sick-listing ≥28 days during follow-up. Results: Univariate and multivariate analyses for calculating relative risks (RR) were carried out. In the Cox regression model age (RR 1.4), strained financial situation (RR 1.3), obesity (RR 1.3), bullying (RR 1.5), physical demands at work higher than own capacity (RR 1.5), and mental demands at work higher than own capacity (1.2) remained risk indicators for long-term sick-listing. Conclusion: This study suggests prevention of some work and lifestyle factors as general measures to reduce long-term sick-listing among women in the public sector.

The same factors influence job turnover and long spells of sick leave—a 3-year follow-up of Swedish nurses

BACKGROUND In many countries, a general shortage of nurses is a public health problem, and retention of nurses in active work is a challenge. The aim of this study was to ascertain whether the same individual factors, working conditions and health problems had led to increased probability of both leaving jobs and prolonged sickness absence in a cohort of Swedish nurses over a period of 3 years. METHODS A baseline questionnaire was answered by 2293 nurses, representing a response rate of 86%. Exposed and unexposed nurses were compared with regard to two outcomes. During the 3-year follow-up, exposed and unexposed nurses were compared with regard to two outcomes: resigning and having at least one sick leave spell that lasted 28 days or longer. RESULTS We found that 18% of the nurses left their employment, and 16% had sick leave spells > or =28 days. Work in geriatric care, being socially excluded by superiors and/or workmates, negative effects of organizational changes and poor self-rated general health were factors that increased the likelihood of both leaving jobs and long-term sick leave. CONCLUSIONS The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

How do job characteristics, family situation, domestic work, and lifestyle factors relate to sickness absence? A study based on Sweden Post.

Objective: We sought to determine how do working life and private life characteristics relate to sickness absence. Methods: Questionnaire data for 1557 female and 1913 male employees were related to registered sickness absence by multivariate analyses. Results: Apart from health problems, clear associations with sickness absence were observed for complaints attributed to heavy, arduous work, and sickness presenteeism. The use of tranquilizers, occurrence of bullying, and the existence of a high total workload from paid and unpaid work were associated with sickness absence in women. In men, the use of alcohol as sedative, anxiety of reorganization, not holding a supervisor position, adverse life events, and divorce were related with sickness absence. Conclusions: Our study identified different areas at work and outside work for women and men that could be targets for actions aiming at preventing high sickness absence.

Work-family interference and long-term sickness absence: a longitudinal cohort study.

BACKGROUND Alongside work environment factors, interference between work and domestic life has been proposed as an important explanation for long-term sickness absence, particularly for women. The aim was to investigate the association between work-to-family interference, family-to-work interference and long-term sickness absence among women and men in different family- and work-related settings. METHODS The study population was a random sample of 2867 gainfully employed adults in Sweden aged 25-50. In 2004, telephone interview data were collected that included questions about family, work and health. The outcome measure was having at least one spell of long-term sickness absence (>14 days) in 2005 based on social insurance register data. Associations were analysed by logistic regression. RESULTS Work-to-family interference was more common than family-to-work interference and more often reported by women. The overall associations with long-term sickness absence were weak. However, after adjustment for age and self-reported health, work-to-family interference was associated with long-term sick leave among men with higher socioeconomic status (odds ratio 2.87; 95% CI 1.36-6.07), and there was also a tendency to association among women bearing the main responsibility for housework and family (1.59; 0.99-2.54). CONCLUSIONS These findings suggest that work-to-family interference is associated with long-term sickness absence in the working population, but in a gender- and situation-specific manner. Hence, extensive work responsibilities for men, and probably extensive family responsibilities for women, could hamper the balance between work and family and increase the risk of long-term sick leave. Further studies are warranted within this area.

Long-term sickness absence: changes in risk factors and the population at risk

OBJECTIVES To investigate changes over time in factors associated with long-term sickness absence (LTSA) and in the fraction of LTSA attributable to these risk factors in 1986-1989 and 2002, respectively. MATERIALS AND METHODS Data from two earlier Swedish studies respectively comprising 1622 and 2009 employees with a history of LTSA (> or = 60 days), and 1019 and 1903 employed members of the general labour force as controls (ages 20-64 years) was used. The studies were conducted before and after extensive changes in the Swedish labour market during the 1990s, and they used sickness absence data from national social insurance records and self-reported information on sociodemographic, lifestyle, and work characteristics. Associations between these factors and LTSA were estimated by logistic regression, and population attributable fractions were calculated. RESULTS The results indicate that, after the 1990s, LTSA was associated with female sex (odds ratio = 1.84, 95% CI: 1.57-2.15) and was also more strongly associated with various aspects of the psychosocial work environment and job situations. A larger population at risk, primarily an ageing workforce, account for a large proportion of LTSA. CONCLUSIONS The results confirm consistent associations between LTSA and several established risk factors, and they also reveal a change in the risk panorama. The current findings demonstrate that, to understand the magnitude of LTSA, both risk factors and the population at risk must be monitored over time. Prevention should aim to create healthy workplaces in general and also focus on female-dominated public sector occupations.

Changes in sickness absenteeism following the introduction of a qualifying day for sickness benefit - findings from Sweden Post

Aims: In 1993, a qualifying day without sickness benefit was introduced to the Swedish sickness benefit system. The aim of the present study is to investigate sickness absenteeism before and after the introduction of the qualifying day, in the light of conditions inside and outside working life. Methods: The study was based on 1,952 female and 2,229 male employees of Sweden Post. Sickness absence was measured by sickness incidence one year before and one year after the introduction of the qualifying day (sick-leave events/person days at risk). Information about explanatory factors was collected by a postal questionnaire in 1994. Results: A decrease in sickness incidence was observed after the introduction of the qualifying day as well as an increase in the mean duration of sick-leave events. The proportion of long-term sick-leave events ( 15-365 days) increased; among men this increase was also found in absolute terms. There were no suggestions of economy being an important determinant for reduced sickness incidence. Women with long-term or serious disease did not show a reduction of sickness incidence to the same extent as those without disease, and for men a coherent result was observed. Men with heavy lifting at work more often showed an increase in incidence compared to men without heavy lifting, and the same tendency was found for women. Conclusion: The reduction in sickness incidence following the introduction of the qualifying day was fairly independent of different work-related and non-work-related factors. The impact of the qualifying day differed depending on health status and the physical workload.

Sickness Absence following Coronary Revascularisation. A National Study of Women and Men of Working Age in Sweden 1994–2006

Background Evidence based and gender specific knowledge about sickness absence following coronary revascularisation is lacking. The objective was to investigate sickness absence after a first coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) among women and men in a national Swedish study. Materials and Methods All patients 30–63 years of age, who underwent a first CABG (n = 22,985, 16% women) or PCI (40,891, 22% women) in Sweden between 1994 and 2006 were included. Information on sickness absence, co-morbidity, and other patient characteristics was obtained from national registers. Long-term sickness absence (LTSA) was defined as >180 and >90 sick-leave days in the first sick-leave spell following CABG and PCI, respectively. Prevalence ratio (PR) and 95% confidence interval (CI) of LTSA were calculated. Findings LTSA followed the interventions in 41% and 36% for CABG and PCI patients, respectively. Women had more often LTSA compared with men, (CABG PR = 1.23: 95% CI 1.19–1.28 and PCI PR = 1.19; 95% CI 1.16–1.23). A history of sickness absence the year before the intervention increased the risk for LTSA after the intervention in both genders. Among women, older age, or being self employed or unemployed was associated with a lower risk for LTSA. Among men previous cardiovascular disease, diabetes and low socio-economic position increased the risk. During the observation period, there was no change in sickness absence rates among PCI patients but an increase among CABG patients adjusting for patient characteristics. Conclusion This national study covering a 13-year period shows that long-term sickness absence following coronary revascularisation is common in Sweden, especially among women, and is associated with socio-economic position, co-morbidity, and sickness absence during the year before the intervention. Gender specific scientific knowledge about use and effects of sickness absence following coronary revascularisation is warranted for the patients, the treating physicians, the healthcare sector, and the society.