Diagnosis From Sick Leave Improves Prediction Of Mortality

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Main Category: Public Health
Also Included In: Primary Care / General Practice
Article Date: 04 Oct 2008 - 0:00 PDT

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More attention should be paid to the health of employees who frequently take sick leave for long durations, according to a study published on bmj.com. Researchers found that compared to colleagues who do not take extended sick leave more than once in three years, employees who do are at a higher risk of death - especially if the leave is for circulatory or psychiatric problems or surgery.

Medically certified sickness absences are a good global measure of health differences between employees because they include almost the full range of illnesses employees experience. Earlier research has suggested that improvements in predicting premature death can come from data on specific reasons for absence, such as psychiatric problems or heart disease.

To test this hypothesis, Jenny Head (University College London) and colleagues analyzed sickness absence records for 6,478 British civil servants between 1985 and 1988 and data on death until 2004. The researchers investigated whether the sickness absence reason could help improve prediction of death compared with overall sickness absence irrespective of diagnosis.

The researchers found that as medically certified absence rates (spells of greater than 7 days) increased, deaths increased. In three years, about 30% of men and women had one or more medically certified absence, and these employees had a 66% increased risk of premature death compared to those who did not have such an absence.

Ultimately, including the diagnosis for sickness led to significant improvements in the ability to predict the risk of death. Employees who were out of work because of circulatory diseases were four times more likely to experience premature death than their colleagues with no absence. Similarly, employees with psychiatric diseases that required leave were about twice as likely to die prematurely. The risk of death was more than two times greater for employees with a surgical operation diagnosis.

One interesting finding was that employees who took one or more spells of absence for a psychiatric diagnosis had a 2.5 times increase in cancer related death. Compared to colleagues that took no absence, those who were out due to a musculoskeletal diagnosis were not at an increased risk of death.

The authors conclude that: "Sickness absence is a serious economic problem with large costs for health care and many lost working hours for businesses.218 We found that the almost 30% of participants who had a sickness absence spell of more than seven days over a three year period had a 66% increased risk of premature death. We do not consider that the taking of sick leave itself is a risk behaviour. Instead, it maybe a marker of circumstances and health problems that increase mortality. We believe that better monitoring of diagnosis-specific absences at population levels may be useful and contribute to policy making - not only as a measure of costs but also as data to identify groups at increased health risk and in need of targeted intervention."

Johannes Anema and Allard van der Beek (VU University Medical Centre, the Netherlands) suggest in an accompanying editorial that, "Specific diagnostic information on sickness absence may provide general practitioners with a useful biopsychosocial tool to identify groups of workers with an increased risk of serious illness and mortality."

"With the help of this tool, they could also identify patients with work related health risks and refer them to occupational physicians for targeted work related interventions," conclude Anema and van der Beek.

Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study
Jenny Head, Jane E Ferrie, Kristina Alexanderson, Hugo Westerlund, Jussi Vahtera, Mika Kivimaki
BMJ (2008).
doi:10.1136/bmj.a1469
Click Here to View Journal Web Site

Written by: Peter M Crosta
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