Objectives: To study the associations between self-reported health problems and sickness absence from work. Methods: The results of a questionnaire survey were combined with archival data of sickness absence of 1341 employees (88% males; 62% blue-collar) in the construction, service and maintenance work within one corporation in Finland. Sex, age and occupational grading were controlled as confounders. A zero-inflated negative binomial (ZINB) regression model was used in the statistical analysis of sickness absence data. Results: The prevalence of self-reported health problems increased with age, from 23% in 18-30-year-olds to 54% in 55-61-year-olds. However, in those aged 18-30 years, 71% had been absent from work and in those aged 55-61 years this proportion was 53%. When health problems and occupational grading were accounted for in the ZINB model, age as such was not associated with the number of days on sick leave, but the young workers still had higher propensity for (any) sickness absence than the old. Self-rated future working ability and musculoskeletal impairment were strong determinants of sickness absence. Among those susceptible to taking sick leave, the estimated mean number of absence days increased by 14% for each rise of 1 unit of the impairment score (scale 0-10). Conclusions: Young subjects had surprisingly high probability for sickness absence although they reported better health than their older colleagues. A higher total count of absence days was found among subjects reporting health problems and poorer working ability, regardless of age, sex and occupational grade. These findings have implications for both management and the healthcare system in the prevention of work disability. S ickness absence means non-attendance by an employee at work due to a (certified) health complaint when the employer expects attendance. Despite the straightforward definition, sickness absence has proved to be a complex phenomenon. In addition to illness, it has been associated with, for example, demographical and socioeconomic factors, organisational features, job content and attitudes to work.1 The key psychosocial predictors of sickness absence include individuals' own perceptions of health and working ability. It is a common belief that older (supposedly in poorer health) employees are more absent from work than their younger (supposedly healthier) colleagues.4 5 However, the young seem to stay out of work due to minor health complaints more than older workers. Also some earlier studies have found that older age increases the risk of overall sickness absences, but decreases that of one-day absences. 6 We investigated how age and self-reported health problems are associated with sickness absence within a cohort predominantly employed in physical work. METHODS Study design and ethicsThe design was cross-sectional: data from questionnaires were combined with records of demographics and sickness absence from the employer's salary register. The Helsinki University Research Ethics Board approved the study, and it ...

Objectives:To evaluate the effectiveness of two occupational health intervention programmes, both compared with usual care.Methods:Based on a health survey, 1341 employees (88% males) in construction, service and maintenance work were classified into three groups: “low risk” (n = 386), “intermediate risk” (n = 537) and “high risk” (n = 418) of sickness absence. Two separate randomised trials were performed in the groups “high risk” and “intermediate risk”, respectively. Those high risk subjects that were allocated to the intervention group (n = 209) were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Among the intermediate risk employees those in the intervention group (n = 268) were invited to call a phone advice centre. In both trials the control group received usual occupational health care. The primary outcome was sickness absence during a 12-month follow-up (register data).Results:The high risk group, representing 31% of the cohort, accounted for 62% of sickness absence days. In the trial for the high risk group the mean sickness absence was 30 days in the usual care group and 19 days in the intervention group; the mean difference was 11 days (95% CI 1 to 20 days). In the trial for the intermediate risk group the mean sickness absence was 7 days in both arms (95% CI of the mean difference –2.3 to 2.4 days).Conclusions:The identification of high risk of work disability was successful. The occupational health intervention was effective in controlling work loss to a degree that is likely to be economically advantageous within the high risk group. The phone advice intervention for the intermediate risk group was not effective in controlling work loss primarily due to poor adherence.

Objectives:To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence.Methods:Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed.Results:After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost €974 and €1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant—both cost saving and more effective than usual occupational health care. The saving was €43 per sickness absence day avoided with available direct total cost data, and €17 with missing total cost data imputed.Conclusions:One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of healthcare resources.