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 (n=13 887) Illness Disease Sickness absence (14%) Wikman et al. J Epidemiol Community Health % 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 year  don’t require medical certificate  Number of long spells (> 7 days) per year  need medical certificate

Age >50 years Short (self-certified) sickness absence spells by age group Age Age Age Rate per 100 person-years Kivimäki et al. (1998)

Age >50 Long (medically certified) sickness absence spells by age group Age Age Age Rate per 100 person-years Kivimäki et al. (1998)

Short (self-certified) sickness absence spells by employment grade North et al, BMJ 1993 age adjusted rate ratios

Long (medically-certified) sickness absence spells by employment grade 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 surgery  These 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 morbidity ONS Psychiatric Morbidity Survey 2000 Sickness Psychiatric morbidity absence No YesOdds 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 morbidity ONS 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 Yes19 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 per 100 person-year Medically certified absence and mortality Risk ratio > >50 Men Women Kivimäki et al. British Medical Journal, 2003 Absence rate

Diagnosis-specific absence and mortality Hazard ratio* Psychiatric disorder Musculoskeletal Infectious Respiratory Circulatory Spells in 3 years Injury Surgical operations Other Diagnosis-specific spells *adjusted for age, sex and employment grade Head et al. BMJ 2008

Diagnosis-specific absence and disability pension Hazard ratio for disability pension Psychiatric disorder Musculoskeletal Spells in 1985 Diagnosis-specific spells (adjusted for age, sex and marital status) Kivimaki et al. J Epidemiol Community Health 2007 Gastrointestinal

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