Indications of a Scarring Effect of Sickness Absence Periods in a Cohort of Higher Educated Self-Employed.
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ABSTRACT: Objectives
Little is known regarding incidence and recurrence of sickness absence in self-employed. The primary aim of this study was to evaluate the influence of the number of prior episodes of sickness absence on the risk of subsequent periods of sickness absence in higher educated self-employed.Methods
In a historic register study based on the files of a Dutch private disability insurance company all sickness absence periods of 30 days or more were analysed.Results
A total of 15,868 insured persons contributed 141,188 person years to the study. In total, 5608 periods of sickness absence occurred during follow-up. The hazard of experiencing a new period of sickness absence increased with every previous period, ranging from a hazard ratio of 2.83 in case of one previous period of sickness absence to a hazard ratio of 6.72 in case of four previous periods. This effect was found for both men and women and for all diagnostic categories of the first period of sickness absence.Conclusions
Our study shows that for all diagnostic categories the hazard of experiencing a recurrence of sickness absence is appreciably higher than for experiencing a first episode. This suggests that this increased hazard may be related to the occurrence of sickness absence itself rather than related to characteristics of the insured person or of the medical condition. These findings could indicate that sickness absence periods may have a scarring effect on the self-employed person experiencing the sickness absence.
SUBMITTER: Wijnvoord LE
PROVIDER: S-EPMC4877097 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundDespite a large proportion of the workforce being self-employed, few studies have been conducted on risk factors for sickness absence in this population. The aim of this study is to identify risk factors for future sickness absence in a population of college and university educated self-employed.MethodsIn a historic register study based on insurance company files risk factors were identified by means of logistic regression analysis. Data collected at application for private disability insurance from 634 applicants were related to subsequent sickness absence periods of 30 days or more during a follow-up period of 7.95 years. Variables studied were self-reported lifestyle variables, variables concerning medical history and present health conditions and variables derived from the general medical examination including blood tests and urinary analysis.ResultsResults from analysis of data from 634 applicants for private disability insurance show that previous periods of sickness absence (OR 2.07), female gender (OR 2.04), health complaints listed in the health declaration (OR 1.88), elevated erythrocyte sedimentation rate (ESR) (OR 4.05) and the nature of the profession were related to a higher risk of sickness absence.ConclusionsSickness absence was found to be related to demographic variables (gender, profession), medical variables (health complaints and erythrocyte sedimentation rate) and to variables with both a medical and a behavioural component (previous sickness absence).
| S-EPMC4108014 | biostudies-literature
Project description:ObjectiveThis study compares the use of sickness absence benefits (SABs) due to a common mental disorder (CMD) between precariously employed and non-precariously employed workers with CMDs.DesignRegister-based cohort study.ParticipantsThe study included 78 215 Swedish workers aged 27-61 who experienced CMDs in 2017, indicated by a new treatment with selective serotonin reuptake inhibitors (SSRIs). Excluded were those who emigrated or immigrated, were self-employed, had an annual employment-based income <100 Swedish Krona, had >90 days of unemployment per year, had student status, had SABs due to CMDs during the exposure measurement (2016) and the two previous years, had an SSRI prescription 1 year or less before the start of the SSRI prescription in 2017, had packs of >100 pills of SSRI medication, had a disability pension before 2017, were not entitled to SABs due to CMDs in 2016, and had no information about the exposure.OutcomeThe first incidence of SABs due to CMDs in 2017.ResultsThe use of SABs due to a CMD was slightly lower among precariously employed workers compared with those in standard employment (adjusted OR [aOR] 0.92, 95% CI 0.81 to 1.05). Particularly, women with three consecutive years in precarious employment had reduced SABs use (aOR 0.48, 95% CI 0.26 to 0.89), while men in precarious employment showed weaker evidence of association. Those in standard employment with high income also showed a lower use of SABs (aOR 0.74, 95% CI 0.67 to 0.81). Low unionisation and both low and high-income levels were associated with lower use of SABs, particularly among women.ConclusionsThe study indicates that workers with CMDs in precarious employment may use SABs to a lower extent. Accordingly, there is a need for (1) guaranteeing access to SABs for people in precarious employment and/or (2) reducing involuntary forms of presenteeism.
| S-EPMC10357787 | biostudies-literature
Project description:ObjectivesSocioeconomic position has been linked to sickness absence (SA). However, less is known about the role of occupational prestige, a measure of social status afforded by one's occupation, in SA. We investigated the association between occupational prestige and SA and the distribution of the association in women and men. We also examined the effect of intersections of gender and occupational prestige on SA.DesignLongitudinal.SettingA nationwide representative sample of Swedish working population.Participants97 397 employed individuals aged 25-59 years selected from the 2004, 2007 and 2010 waves of the Swedish Labour Force Survey and prospectively linked to the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies.Outcome measuresThe number of SA days in any particular year during a 3-year follow-up and long-term (>120 days) SA based on those with at least one sick leave spell during the follow-up.ResultsOccupational prestige was weakly associated with SA in the total sample after adjusting for potential confounders. In the gender-stratified analysis, women in lower prestige occupations had higher absenteeism rates than women in high prestige occupations; men in lower prestige occupations had higher odds for long-term SA than men in high prestige occupations. In the intersectional analysis, women regardless of prestige level and men in lower prestige occupations had higher probability of SA compared with men in high prestige occupations. Women in high prestige occupations had the highest absenteeism rates (incidence rate ratio (IRR), 2.25, 95% CI, 2.20 to 2.31), while men in medium prestige occupations had the lowest rates (IRR, 1.17, 95% CI, 1.13 to 1.20). Compared with the rest of the groups, men in low and medium prestige occupations had higher odds for long-term absence.ConclusionThere is need to pay close attention to occupational prestige as a factor that may influence health and labour market participation.
| S-EPMC8190050 | biostudies-literature
Project description:ObjectivesEarly withdrawal from work is common among people with multiple sclerosis (PwMS). However, little is known about how this is influenced by the type of employment. The aims were to explore the distributions of self-employed and other types of employment (employed or no earnings from work) before and after MS diagnosis and its associations with sickness absence (SA) and disability pension (DP) among PwMS and matched references without MS.Materials & methodA 6-year longitudinal cohort study of 2779 individuals diagnosed with MS in 2008-2012 when aged 20-59 and of 13,863 matched individuals without MS from Sweden's population was conducted. Hazard ratios (HR) of >180 SA and/or DP days/year were compared by employment status among PwMS and references using Cox proportional hazard models with 95% confidence intervals (CI).ResultsMost had no SA or DP. Nevertheless, PwMS had higher SA and DP levels compared with references. PwMS had a higher likelihood to reach >180 days of SA (HR = 4.89, 95% CI = 4.43-5.40) or days of DP (HR = 6.31, 95% CI = 5.46-7.30), irrespective of the employment status. Self-employed references had less likelihood for >180 SA days than employed references. However, self-employed and employed PwMS had a similar likelihood for >180 SA days. Transitions of employees to self-employment were infrequent among PwMS (1.7%) and references (2.6%).ConclusionsPwMS transit to SA and DP to a higher extent than references. In contrast to individuals without MS, self-employed PwMS had similar SA levels to employed PwMS. Switching to self-employment was not a predominant choice for people recently diagnosed with MS.
| S-EPMC9544424 | biostudies-literature
Project description:Most research on long-term sickness absence has focussed on exposure to occupational psychosocial risk factors such as low decision latitude. These provide an incomplete explanation as they do not account for other relevant factors. Such occupational risk factors may be confounded by social or temperamental risk factors earlier in life.We analysed data from the 1958 British Birth Cohort. Long-term sickness absence was defined as receipt of Incapacity Benefit/Severe Disablement Allowance at age 42. In those in employment aged 33 we examined the effects of psychological distress, musculoskeletal symptoms, and low decision latitude. These were then adjusted for IQ, educational attainment, and the presence of early life somatic and neurotic symptoms.Low decision latitude predicted subsequent long-term absence, and this association remained, albeit reduced, following adjustment for psychological distress and musculoskeletal symptoms at age 33. Low decision latitude was no longer associated with long-term absence when IQ and educational attainment were included. Adjusting for early life somatic and neurotic symptoms had little impact.A greater understanding of the ways in which occupational risk factors interact with individual vulnerabilities across the life-course is required. Self reported low decision latitude might reflect the impact of education and cognitive ability on how threat, and the ability to manage threat, is perceived, rather than being an independent risk factor for long-term sick leave. This has implications for policy aimed at reducing long-term sick leave.
| S-EPMC3343027 | biostudies-other
Project description:BackgroundThe high cost of training and the relatively long period of training for physicians make it beneficial to stimulate physicians to retire later. Therefore, a better understanding of the link between the factors influencing the decision to retire and actual turnover would benefit policies designed to encourage later retirement. This study focuses on actual GP turnover and the determining factors for this in the Netherlands. The period 2003-2007 saw fewer GPs retiring from general practice than the period 1998-2002. In addition, GPs' retirement age was higher in 2003-2007. For these two periods, we analysed work perception, objective workload and reasons for leaving, and related these with the probability that GPs would leave general practice at an early age.MethodsIn 2003, a first retrospective survey was sent to 520 self-employed GPs who had retired between 1998 and 2002. In 2008, the same survey was sent to 405 GPs who had retired between 2003 and 2007. The response rates were 60% and 54%, respectively. Analyses were done to compare work perception, objective workload, external factors and personal reasons for retiring.ResultsFor both male and female GPs, work perception was different in the periods under scrutiny: both groups reported greater job satisfaction and a lower degree of emotional exhaustion in the later period, although there was no notable difference in subjective workload. The objective workload was lower in the second period. Moreover, most external factors and personal reasons that may contribute to the decision to retire were reported as less important in the second period. There was a stronger decrease in the probability that female GPs leave general practice within one year than for male GPs. This underscores the gender differences and the need for disaggregated data collection.ConclusionsThe results of this study suggest that the decrease in the probability of GPs leaving general practice within one year and the increasing retirement age are caused by a decrease in the objective workload, a change in GPs' work perception, external factors and personal reasons. Based on the results of this study, we consider workload reduction policies are the most useful instruments to control retention and retirement.
| S-EPMC3541202 | biostudies-literature
Project description:BackgroundEarlier studies have suggested that sickness presenteeism (SP) may be a risk factor for future health problems. The purpose of the present study was to test this in a nationally representative prospective study of Swedish workers.MethodsProspective cohort with a representative sample of the Swedish working population surveyed in 2008 and 2010. Odds ratios (OR) with 95% confidence intervals (CI) were calculated using logistic regression.ResultsThose who reported more than 7 days of SP had higher risk of suboptimal SRH compared to those who reported no SP (OR = 5.95; 95% CI 4.98-7.12), also after adjustment for confounders (OR = 1.64; 95% CI 1.30-2.06). Those who reported 1-7 days of SP also had an increased risk before and after adjustments. Inclusion of self-rated physical and psychological work capacity did not attenuate the associations, whereas of emotional exhaustion attenuated the ORs to non-significance for both outcomes, indicating that the health consequences associated with SP are largely related to mental health.ConclusionThe results strengthen earlier findings suggesting that SP can be a risk factor for future suboptimal general health and sickness absence, particularly through mental health problems. This indicates that asking about SP could yield important information for employers, occupational health practitioners and GPs, possibly leading to more timely intervention that could decrease the risk of future sickness absence and more serious health problems, especially in the mental domain. Further studies of the possible causal pathways between SP and future health development are also warranted, especially since going to work is often seen as desirable also for those with poor health.
| S-EPMC3439368 | biostudies-literature
Project description:The aim of this study is to assess the impact of combined work and family demands on all-cause sickness absence and to examine variation in this relationship by occupational grade and gender.The study sample consists of 13,179 employees of Electricité de France-Gaz de France (EDF-GDF) who were members of the GAZEL occupational cohort in 1995. Combined work and family demands are assessed based on measures of job strain and number of dependants assessed at baseline (1995). Covariates include occupational grade and demographic, behavioural and social variables assessed at baseline. Ratios of sickness absence days to total person-days contributed by each employee were established from administrative data between baseline and the end of follow-up in 2003. Rate ratios across levels of work-family demands were then calculated. Effect modification by gender and grade of employment was tested.In fully adjusted models, individuals with the highest work-family demands had a rate ratio of sickness absence of 1.78 (95% CI 1.47-2.14) compared with low-demand workers. This association was independent of occupational grade and did not vary with gender. Results were not attributable solely to psychiatric sickness absences.High work-family demands at baseline predict long-term all-cause sickness absence across a socio-economically diverse occupational cohort.
| S-EPMC3265751 | biostudies-literature
Project description:ObjectivesDespite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns' interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity.DesignA register-based prospective cohort study.SettingAdministrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data.ParticipantsIndividuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included.Primary and secondary outcome measuresThe primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL.ResultsThree distinct patterns of SA were identified; 'Stable', 'Quick decrease' and 'Gradual decrease'. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable.ConclusionThe study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.
| S-EPMC6677943 | biostudies-literature
Project description:Aims To examine the longitudinal associations between cannabis use and risks of short (<7 days), medium (7-28 days), and long (>28 days) sickness absences at one-year follow-up. Methods 87,273 participants aged 18-65 years from the French CONSTANCES cohort reported their frequency of cannabis use at inclusion between 2012 and 2018. Sickness absences occurring during one year of follow-up were collected from national medico-administrative registries. Multivariable generalized linear regressions were used to compute the Odds Ratios (OR) with their 95% Confidence Intervals (CI) of having at least one sickness absence at follow-up compared to no sickness absence, while controlling for sociodemographic factors, chronic conditions and occupational factors. Results Cannabis use more than once a month was associated with an increased risk of short (OR, [95% CI]: 1.56 [1.32–1.83]) and medium (1.29 [1.07–1.54]) sickness absences at one-year follow-up, with dose-dependent relationships for short sickness absences (1.13 [1.08–1.18], p-for-trend <0.001). In stratified analyses, cannabis use was associated with an increased risk of sickness absences in older individuals, men, participants with good self-rated health, living or having lived as a couple, and having an open-ended contract. Conclusions Cannabis use prospectively increased the risk of short and medium sickness absences, even from once a month and with a dose-dependent relationship for short sickness absences. These findings should be considered in information and prevention public health campaigns to alert the general population and workers to this increased risk.
| S-EPMC9197417 | biostudies-literature