Within-individual analysis of pain and sickness absence among employees from low and high occupational classes: a record linkage study

Abstract

ObjectivesPain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics.MethodsThe Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models.ResultsAcute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19–1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10–1.50] for acute/subacute and 1.43 [1.23–1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08–1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations).ConclusionsThese results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.

Separate and joint associations of chronic pain, multisite pain and mental health with sickness absence among younger employees: a register based longitudinal study

“…Physical and psychosocial strain at work have been linked to both pain and SA [ 47 – 49 ]. Occupational class differences in the association between pain and SA have been documented, and work-related factors likely contribute to the causal pathway between pain, mental health, and SA [ 50 ]. To avoid overadjustment bias, we did not adjust the analyses for work-related factors.…”

A longitudinal study of changes in interactional justice and subsequent short-term sickness absence among municipal employees

“…However, it has been shown that conditional fixed effects do not truly control for the fixed covariates when used with negative binomial regression models (25). To overcome the limitations of both models, an alternative solution, a so-called hybrid model, was selected as proposed by Allison (26) in the spirit of Mundlak (27) and previously used elsewhere (28)(29)(30). In the hybrid model, a random effects model is fitted with two variables for each time-varying regressor: individualspecific mean value and individual-specific variance to control for the between-and within-individual effects, respectively.…”

Contributions of childhood adversities to chronic pain among mid-life employees

“…Chronic pain is common among employees and in work life. It is associated with problems such as reduced work capacity [ 1 ] and sickness absence [ 2 ]. There is increasing evidence that childhood adversities contribute to various adult health outcomes [ 3 , 4 ].…”