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BMJ. 2003 Aug 16;327(7411):364.

Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study.

Author information

  • 1Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland. mika.kivimaki@ttl.fi

Abstract

OBJECTIVE:

To examine the association between sickness absence and mortality compared with associations between established health indicators and mortality.

DESIGN:

Prospective cohort study. Medical examination and questionnaire survey conducted in 1985-8; sickness absence records covered the period 1985-98.

SETTING:

20 civil service departments in London.

PARTICIPANTS:

6895 male and 3413 female civil servants aged 35-55 years.

MAIN OUTCOME MEASURE:

All cause mortality until the end of 1999.

RESULTS:

After adjustment for age and grade, men and women who had more than five medically certified absences (spells > 7 days) per 10 years had a mortality 4.8 (95% confidence interval 3.3 to 6.9) and 2.7 (1.5 to 4.9) times greater than those with no such absence. Poor self rated health, presence of longstanding illness, and a measure of common clinical conditions comprising diabetes, diagnosed heart disease, abnormalities on electrocardiogram, hypertension, and respiratory illness were all associated with mortality--relative rates between 1.3 and 1.9. In a multivariate model including all the above health indicators and additional health risk factors, medically certified sickness absence remained a significant predictor of mortality. No linear association existed between self certified absence (spells 1-7 days) and mortality, but the findings suggest that a small amount of self certified absence is protective.

CONCLUSION:

Evidence linking sickness absence to mortality indicates that routinely collected sickness absence data could be used as a global measure of health differentials between employees. However, such approaches should focus on medically certified (or long term) absences rather than self certified absences.

PMID:
12919985
[PubMed - indexed for MEDLINE]
PMCID:
PMC175810
Free PMC Article
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