general aspects of sickness absence jenny head department of epidemiology and public health ucl...
TRANSCRIPT
General aspects of sickness absence
Jenny Head Department of Epidemiology
and Public Health UCL
OUTLINE
Does sickness absence reflect ill-health?
Age and employment grade differences
Diagnoses for sickness absence
Mental health problems and sickness absence
Consequences of sickness absence
Ill health: one hypothesised model
Illness
Disease
Sickness absence
Ill health: alternative model
Illness
Disease
Sickness absence
Percentage of employed in Sweden 1998-2001 (n=13 887)
Illness
Disease
Sickness absence (14%)
Wikman et al. J Epidemiol Community Health 2005
33%
23%
2%
5%
3%
All three
8%
1%
None of these
25%
Does sickness absence reflect ill-health?
Strong association between measures of morbidity (overall health status, reported health problems, heart disease, diabetes, respiratory disease, psychiatric symptoms) and rates of sickness absence
The longer the duration of absence, the stronger the association
But health status also related to rates of short spells of absence (1-2 days, 3-7 days)
Marmot et al, J Epidemiol Community Health 1995
Personnel (%)
A problem in organisational absence statistics:Majority of absence days attributable to small number of very long absence spells
Sickness days (%)
Sickness absence measures
Number of days per year
Number of short spells (<= 7 days) per yeardon’t require medical certificate
Number of long spells (> 7 days) per yearneed medical certificate
0
25
50
75
100
125
150
175
Age >50 years
Short (self-certified) sickness absence spells by age group
Age 41 - 50
Age 31 - 40Age 18 - 30
Rate per 100 person-years
Kivimäki et al. (1998)
0
20
40
60
80
100
Age >50
Long (medically certified) sickness absence spells by age group
Age 41 - 50Age 31 - 40
Age 18 - 30
Rate per 100 person-years
Kivimäki et al. (1998)
Short (self-certified) sickness absence spells by employment grade
0
1
2
3
4
5
6
7
1 2 3 4 5 6
Employment grade
Rate
rati
o
Men
Women
North et al, BMJ 1993age adjusted rate ratios
Long (medically-certified) sickness absence spells by employment grade
0
1
2
3
4
5
6
7
1 2 3 4 5 6
Employment grade
Rate
rati
o
Men
Women
age adjusted rate ratios
North et al, BMJ 1993
Employment grade and gender differences
There are differences in rates of sickness absence by grade, gender and age
Important to take account of differences in composition when comparing groups
For example: Comparing sickness absence rates in different parts of
the organisation Comparing rates in men and women
Diagnoses for sickness absence
Short spells <= 7 days (self certificated)Respiratory, gastrointestinal, headaches,
musculoskeletal, injury, psychiatric disorder
Long spells >7 days (medical certificate)Respiratory, musculoskeletal, psychiatric,
infectious disease, injury and surgeryThese diagnoses account for about 75% of all
medically certified spells
Stansfeld et al. Soc. Sci. Med 1995
Head et al. BMJ 2008
Psychiatric morbidity as reason for absence
Psychiatric disorder was third most common diagnosis for absence of long spells in women and fourth most common cause in men
Accounts for around 10% of all long spells in both men and women
Stansfeld et al. Soc. Sci. Med 1995
Sickness absence by psychiatric morbidityONS Psychiatric Morbidity Survey 2000
Sickness Psychiatric morbidity
absence No Yes Odds ratio
in last year
Any time off 27% 50% 2.7
>=6 days 14% 36% 3.6
Stansfeld et al, HSE research report
Sickness absence by psychiatric morbidityONS Psychiatric Morbidity Survey 2000
About 30% of total days lost are ‘attributable’ to psychiatric morbidity
Psychiatric morbidity Mean number of days off in last year
No 5 days
Yes 19 days
Stansfeld et al, HSE research report
Consequences of sickness absence
Early exit from labour force - disability pension/early retirement on health grounds
Mortality
0
1
2
3
4
5
0 per 100 person-year
Medically certified absence and mortalityRisk ratio
1-20
21-50
>50
01-20
21-50
>50
Men Women
Kivimäki et al. British Medical Journal, 2003Absence rate
1.8
1.9
2.2
1.7
1
1.6
4.7
1
1.5
0 1 2 3 4 5 6
>1
>1
>1
>1
>1
>1
>1
>1
0
Diagnosis-specific absence and mortality
Hazard ratio*
Psychiatric disorder
Musculoskeletal
Infectious
Respiratory
Circulatory
Spells in 3 years
Injury
Surgical operations
Other
Diagnosis-specificspells
*adjusted for age, sex and employment gradeHead et al. BMJ 2008
3.9
4.1
5
3
1
0 1 2 3 4 5 6
>1
>1
>1
>1
0
Diagnosis-specific absence and disability pension
Hazard ratio for disability pension 1991-1996
Psychiatric disorder
Musculoskeletal
Spells in 1985
Diagnosis-specificspells
(adjusted for age, sex and marital status)
Kivimaki et al. J Epidemiol Community Health 2007
Gastrointestinal
