Smoking and sickness absence: a systematic review and meta-analysis

Abstract

Smoking and sickness absence: a systematic review and meta-analysis by Troelstra SA, Coenen P, Boot CRL, Harting J, Kunst AE, van der Beek AJSmoking increased both the risk of sickness absence and the number of sickness absence days, regardless of gender, age, study location, and occupational class. This suggests that all employers and employees, irrespective of these characteristics, could equally benefit from smoking cessation, and therefore that all employee populations should equally be offered the opportunity to participate in smoking cessation interventions. Troelstra SA. Coenen P, Boot CRL, Harting J, Kunst AE, van der Beek AJ. Smoking and sickness absence: a systematic review and meta-analysis. Scand J Work Environ Health. 2020;46(1):5-18. doi:10.5271/sjweh.3848Objectives Evidence on the effect of smoking on sickness absence could guide workplace smoking cessation interventions and encourage employers to promote smoking cessation among their employees. This systematic review and meta-analysis aimed to summarize evidence on the association between smoking and sickness absence and determine whether there are differences in this association for study design, methodology, and sample characteristics. MethodsWe searched for studies that reported on smoking status and sickness absence, used empirical data, were published in a peer-reviewed journal in the last 25 years, and written in English. We conducted pooled analyses in which uni-and multivariate generalized linear regression models were applied. ResultsAfter screening 2551 unique records, 46 articles from 43 studies were included, of which 33 studies (with 1 240 723 participants) could be included in the pooled analyses. Smoking was associated with an 31% increase in risk of sickness absence compared to non-smoking (95% confidence interval (CI) 1.24-39). We did not find statistically significant different effect sizes for study location, gender, age, occupational class, study design, assessment of sickness absence, short-versus long-term sickness absence, and adjustment for relevant confounders. Furthermore, smoking was associated with 2.89 more sickness absence days per year compared to non-smoking (95% CI 2.08-3.70). ConclusionsWe found robust evidence showing that smoking increases both the risk and number of sickness absence days in working populations, regardless of study location, gender, age, and occupational class. Encouraging smoking cessation at the workplace could therefore be beneficial for employers and employees.

Associations of sustained smoking and smoking cessation with work-related outcomes: a longitudinal analysis

“…As an additional analysis we dichotomized sickness absence and found an odds ratio of 1.10 (95% CI 0.92-1.30) comparing sustained smoking with non-smoking. This 95% confidence interval, when interpreted as a relative risk, is lower but overlaps with the confidence intervals of risk of sickness absence for sustained smokers compared to non-smokers as reported in two recent systematic reviews (1.24-1.39 and 1.25-1.41, respectively) (Troelstra et al 2020;Weng et al 2013). This indicates that even though our findings are unexpected, they are within the range found by other studies.…”

“…However, this difference was not statistically significant. This is in contrast to two systematic reviews on the relation between sustained smoking and sickness absence (Troelstra et al 2020;Weng et al 2013), but in correspondence with several individual studies included in the systematic review which also did not find statistically significant associations between smoking and sickness absence (Boles et al 2004;Karlsson et al 2010;Kivimäki et al 1997;Pai et al 2009). A potential explanation for our results could be over-adjustment for health status.…”

Implementation of Financial Incentives for Successful Smoking Cessation in Real-Life Company Settings: A Qualitative Needs Assessment among Employers

“…The cost-effectiveness of financial incentives was also generally believed, but some employers did not see immediate financial benefits of stimulating smoking cessation in their own company. Therefore, it may be important for the implementation of smoking cessation trainings with incentives that employers are provided with a compelling 'business case', which gives an overview of the costs of smoking employees [26,27] and the financial benefits to their company if they invest in helping employees to quit smoking.…”

Barriers to introduction of smoke-free workplaces in Central Europe: example of the Czech Republic

“…The total of unproductive salary costs can be calculated. Smokers also have more sick days compared to non-smokers: between 3 to 7 more days per year (17,18). This corresponds with the proven fact that the main cost of smoking to a nation's economy is the loss of productive working life.…”