Consequences of worksite hypertension screening. Changes in absenteeism.

Abstract

SUMMARY To confirm reports of increased absenteeism after worksite hypertension screening, we performed a three-stage blood pressure screening among 5888 self-selected heterogeneous workers at 11 electronics plants using standardized screening and labeling procedures. A total of 296 subjects with mean systolic blood pressure of 140 mm Hg or greater or diastolic blood pressure of 90 mm Hg or greater on all three occasions were considered to have sustained hypertension. From the untreated normotensive subjects matched for eight sociodemographic and occupational variables, we prospectively selected one to three controls for each sustained hypertensive subject. Uncorrected absenteeism rates for sustained hypertensive subjects increased 22% from baseline in the postscreening year. Correction by logarithmic transformation for skewed distributions and by rates for matched controls for temporal trends reduced these changes to statistical insignificance with high statistical power. Several subgroups exhibited trends to increased absenteeism. At 12-month follow-up, the blood pressure of the sustained hypertensive subjects showed mean decreases of 12.6/6.7 mm Hg (p<0.0001) after the majority had received pharmacological antihypertensive treatment. These results suggest that worksite hypertension screening and labeling produce insignificant absenteeism change overall among self-selected heterogeneous work force populations. (Hypertension 10: 425-436, 1987) KEY WORDS • absenteeism • hypertension screening • labeling H YPERTENSION is the most common principal diagnosis cited by U.S. physicians during office visits, accounting for nearly 24 million visits annually, or 5% of the total.1 Despite substantial improvement in the proportion of Americans newly diagnosed as hypertensive and brought to treatment, major problems remain. By recently revised criteria, about 46% of hypertensive Americans are still undiagnosed, especially younger adults with mild disease. In nearly 21% hypertension is diagnosed but untreated, and in 22% it is treated but still uncon-

Increased absenteeism from work among aware and treated hypertensive and hypercholesterolaemic patients

“…Had, in contrast, the screening examination been experienced as an occasion of labelling for previously unaware subjects, then our results would still be consistent with the prospective results of the Dofasco [1] and Charlson et al [2] studies, and even in a way with the results of Rudd et al [7], albeit without being able to compare differences in sick leave before and after screening.…”

“…According to Rudd and his co-workers [7], the main sources of bias in the majority of studies are due to homogeneity and thus the non-representative nature of the study population (as for instance steel workers in the Dofasco study [1] or insurance company clerks in the Charlson et al study [2]), non-standardized labelling techniques, retrospective or incomplete selection of control groups and potential coexistence of incentives for absenteeism.…”

Hypertension labelling was associated with poorer self-rated health in the Third US National Health and Nutrition Examination Survey

“…4 However, screening and detection leads to the labelling of individuals as hypertensive and such labelling may adversely affect some health indices. For example, some studies show that labelling increases work absenteeism [5][6][7] while others show that labelled hypertensives have lower selfrated health (SRH) than normotensives. [8][9][10][11][12][13][14][15] This apparent SRH effect of labelling has been reported in comparisons of labelled and unlabelled (unaware hypertensive) persons 11 and may occur in individuals mislabelled (i.e., normotensive persons misdiagnosed as hypertensive).…”

Impact of Diabetes Screening on Quality of Life

“…However, the experience of being identified with a chronic disease may itself lead to a decline in HRQoL. This phenomenon, sometimes called "labeling," has been demonstrated in the case of mass screening for abdominal aortic aneurysm (4) and may exist as well in screening for hypertension (5)(6)(7).…”