1. General aspects of sickness absence Jenny Head Department of Epidemiology and Public Health UCL j.head@ucl.ac.uk

2. 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

3. Ill health: one hypothesised model Illness Disease Sickness absence

4. Ill health: alternative model Illness Disease Sickness absence

5. 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%

6. 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

7. Personnel (%) A problem in organisational absence statistics: Majority of absence days attributable to small number of very long absence spells Sickness days (%)

8. 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

9. Age >50 years Short (self-certified) sickness absence spells by age group Age 41 - 50 Age 31 - 40 Age 18 - 30 Rate per 100 person-years Kivimäki et al. (1998)

10. Age >50 Long (medically certified) sickness absence spells by age group Age 41 - 50 Age 31 - 40 Age 18 - 30 Rate per 100 person-years Kivimäki et al. (1998)

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

12. Long (medically-certified) sickness absence spells by employment grade age adjusted rate ratios North et al, BMJ 1993

13. 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

14. 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

15. 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

16. 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

17. 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

18. Consequences of sickness absence  Early exit from labour force - disability pension/early retirement on health grounds  Mortality

19. 0 per 100 person-year Medically certified absence and mortality Risk ratio 1-20 21-50 >50 0 1-20 21-50 >50 Men Women Kivimäki et al. British Medical Journal, 2003 Absence rate

20. 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

21. Diagnosis-specific absence and disability pension Hazard ratio for disability pension 1991-1996 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

22. Thank you! j.head@ucl.ac.uk