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Int J Behav Med. 2018 Jun;25(3):362-367. doi: 10.1007/s12529-017-9700-1.

Association Between Cortisol to DHEA-s Ratio and Sickness Absence in Japanese Male Workers.

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Department of Nursing, Baika Women's University, 2-19-5 Shukunosho, Ibaraki, Osaka, 567-8578, Japan.
Department of Welfare System and Health Science, Okayama Prefectural University, 111 Kuboki, Soja, Okayama, 719-1197, Japan.
Department of Public Health, Sanyo Gakuen University Graduate School of Nursing, 1-14-1 Hirai, Naka-ku, Okayama, 703-8501, Japan.
Department of Public Health, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0374, Japan.



This study aimed to investigate the association between serum levels of cortisol and dehydroepiandrosterone sulfate (DHEA-s) and sickness absence over 2 years in Japanese male workers.


A baseline survey including questions about health behavior, along with blood sampling for cortisol and DHEA-s, was conducted in 2009. In total, 429 men (mean ± SD age, 52.9 ± 8.6 years) from whom blood samples were collected at baseline were followed until December 31, 2011. The hazard ratios (HR) and 95% confidence intervals (CI) for sickness absence were calculated using a Cox proportional hazard model, adjusted for potential confounders.


Among 35 workers who took sickness absences, 31 had physical illness. A high cortisol to DHEA-s ratio increased the risk of sickness absence (crude HR = 2.68, 95% CI 1.12-6.41; adjusted HR = 3.33, 95% CI 1.35-8.20). The cortisol to DHEA-s ratio was linearly associated with an increased risk of sickness absence (p for trend < .050). Single effects of cortisol and DHEA-s levels were not associated with sickness absences. This trend did not change when limited to absences resulting from physical illness.


Hormonal conditions related to the hypothalamus-pituitary-adrenocortical axis and adrenal function should be considered when predicting sickness absence. The cortisol to DHEA-s ratio may be more informative than single effects of cortisol and DHEA-s levels.


Cortisol; DHEA-s; Japanese male workers; Prospective study; Sickness absence

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