Monica Ubalde-Lopez

Cross-national comparisons of sickness absence systems and statistics: towards common indicators

We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons.

0095 Multimorbidity and previous sickness absence episodes are determinants of incidence and duration of future episodes

Objectives While sociodemographic and work-related factors are frequently studied as determinants of sickness absence (SA), health-related determinants have surprisingly received little attention. We examined the effect of multimorbidity and previous SA on the incidence and duration of future SA. Method A retrospective (2004–2008) cohort of 373,905 workers who underwent a standardised medical evaluation in 2006 from which information on chronic conditions, health-related symptoms and behaviours was used to construct a sex-specific multimorbidity score (MMBS). Information on SA episodes occurring during the two years prior to the examination came from the employment history. We estimated the effect of the MMBS and prior SA on the 2-year incidence and duration of SA post-examination using a Cox model adjusted for age and occupational social class. Effects on SA duration were also adjusted for diagnosis. Results Men, but not women, showed an effect with a trend of higher SA incidence risk from low (HR=1.06; 95% CI: 1.01–1.11) to high MMBS (HR=1.22; 95% CI: 1.18–1.28). Having five or more prior episodes was related to higher SA incidence risk, both in men (HR=2.19 95% CI: 2.11–2.28) and in women (HR=2.47; 95% CI: 2.35–2.61). Women, but not men, had longer SA duration from low (HR=0.91; 95% CI: 0.83–0.99) to high MMBS (HR=0.88; 95% CI: 0.78–0.99). Having 5 or more prior SA episodes was related to shorter duration in men (HR=1.67; 95% CI: 1.30–2.16) and women (HR=2.12; 95% CI: 1.56–2.89). Conclusions Multimorbidity increases the risk of higher SA incidence and duration while the effect of prior SA episodes is more complex.

0012 A holistic approach to calculating a multimorbidity score: the usefulness of multi-correspondence analysis

Objectives Most frequently, multimorbidity measures available in the literature are heavily dependent on one outcome. We propose a method to construct a global multimorbidity score that incorporates chronic and non-chronic health conditions as well as health-related behaviours and symptoms, regardless of any specific outcome. Method Cross-sectional study of 373 905 Spanish workers who underwent a standardised medical evaluation in 2006. By applying an algorithm based on the results of a multi-correspondence analysis we computed a multimorbitidy score separated by sex.The score distribution was described by age groups and occupational social class for both sexes. Results Two dimensions were generated by the multi-correspondence analysis that explained around 80% of the total variability in both sexes. The main dimension was related to cardiovascular chronic conditions and personal habits, whereas the second dimension included symptoms, in addition to sleep disturbances in women. As compared to women, men showed a higher prevalence of multimorbidity (78% vs 17%), higher scores [mean 14 (SD 11.9) versus mean 9 (SD 9.5)], and a rising trend with age. No differences were found by occupational social class. Conclusions Multimorbidity can reflect clustering of health-related conditions, providing information on its burden and distribution in a specific population By calculating a multimorbidity score that considers both health-related conditions and symptoms, we provide a more holistic approach to multimorbidity, applicable to any database.

The effect of multimorbidity on sickness absence by specific diagnoses

Background As the worlds population ages, the prevalence of multiple chronic and non-chronic health-related conditions is increasing. Research on multimorbidity, the co-occurrence of two or more health-related conditions, has mainly involved patient and older populations. Its effect in working populations, presumably younger and healthier, is not well known but could conceivably affect sickness absence (SA) and ability to return to work. Aims To examine the effect of multimorbidity on the incidence and duration of SA episodes by frequent diagnostic groups. Methods A prospective study (in 2006-2008) of workers in Spain. Information on health-related conditions was gathered with a standardized questionnaire and used to construct a sex-specific multidimensional multimorbidity score (MDMS). In order to estimate the effect of MDMS on incidence and duration of SA episodes due to cardiovascular diseases (CVD), musculoskeletal disorders (MSD) and mental health disorders (MHD), we fitted Cox models adjusted by age, occupational social class and number of prior SA episodes for both sexes. Results The study population was 372370. Men with high MDMS showed a trend towards higher incidence risk for SA due to CVD and MSD [adjusted hazard ratio (aHR) = 2.03; 95% confidence interval (CI) 1.48-2.78 and aHR = 1.20; 95% CI 1.01-1.43, respectively]. Women showed a similar trend for MSD, but MHD had the strongest association (aHR = 4.78; 95% CI 1.97-11.62) for high MDMS. In both sexes, the effect of MDMS was strongest among those without a prior SA. No consistent associations with SA duration were observed. Conclusions Multimorbidity increased the risk of incident musculoskeletal, mental and cardiovascular SA episodes but not their duration.

O39-6 Burden of occupational diseases treated in the spanish national health system: the occupational disease unit at parc de salut mar/university pompeu fabra

Objectives The identification and recognition of occupational diseases (OD) has important and longstanding limitations in Spain. The creation of an Occupational Disease Unit (ODU) at the Parc de Salut Mar health system (PSMAR) in 2010 is among the latest innovative initiatives to address these restraints. Its aims are to identify, evaluate and report suspected cases of OD among PSMAR patients, based on the collaboration of clinical and occupational health services, and patients. Methods Prospective clinical study of a series of suspected cases of OD identified at PSMAR between 2010 and 2014, referred to the ODU for an in-depth protocol-driven confirmatory clinical evaluation, leading to a standardised causation report. Confirmed cases were followed up to provide continued support. The official OD recognition process was tracked to determine whether it had been initiated and followed to final administrative closure. Results A total of 115 potential cases were referred to ODU by PSMAR health system physicians, of which 46 (40%) were confirmed as cases of suspected OD. The majority of confirmed cases were men (80%), with diagnoses of hearing loss (43%), musculoskeletal disorders (24%), cancer (22%) and dermatoses (11%). The positive predictive value was 39% (95% CI = 27.39–50.99). With respect to final administrative decision, 14 of 31 patients who initiated the official recognition process were rejected, 4 remained open, and 13 had been recognised as OD. Of these, 11 were recognised by the administrative route and two through litigation. The mean time to recognition was 295 days. Conclusions The results obtained from this experience have shown the ODU to be useful and effective. The challenge now is to expand this approach for identification and management of OD to other hospitals of the Spanish National Health Service. Fondo de Investigaciones Sanitarias (FIS: PI12/02556), Instituto de Salud Carlos III, Subdireccion General de Evaluacion y Fomento de la Investigacion, Ministerio de Ciencia e Innovacion, Spanish Government

Sickness absence among health workers in belo horizonte, brazil

To describe the prevalence of sickness absence and to analyze factors associated with the outcome according to gender in a sample of healthcare workers at the Belo Horizonte Health Department.