Elsevier

The Lancet

Volume 363, Issue 9416, 10 April 2004, Pages 1193-1197
The Lancet

Articles
Workplace expansion, long-term sickness absence, and hospital admission

https://doi.org/10.1016/S0140-6736(04)15949-7Get rights and content

Summary

Background

Downsizing has in previous studies, as well as in public debate, been associated with increased sickness absence. No studies have, however, looked at the long-term relation between workplace expansion and morbidity.

Methods

We investigated exposure to personnel change during 1991–96 in relation to long-term (90 days or longer) medically certified sickness absence and hospital admission for specified diagnoses during 1997–99 in 24036 participants with a complete employment record in the biennial national Swedish Work Environment Surveys from 1989 to the end of 1999.

Findings

Accumulated exposure to large expansion (≤18% per year) was related to an increased risk of long-term sickness absence (odds ratio 1·07 [95% CI 1·01–1·13], p=0·013) and hospital admission (1·09 [1·02–1·16], p=0·017). In this context, odds ratio signifies the change in odds for each additional year of exposure, varying from 0 to 6. Moderate expansion (≤8% and <18% per year), was associated with a decreased risk of admission (0·91 [0·84–0·98], p=0·012). Moderate downsizing (≤8% and <18% per year) was associated with an increased risk of sickness absence (1·07 [1·02–1·12], p=0·003). The strongest association between large expansion and sickness absence was in women in the public sector (1·18 [1·08–1·30], p=0·0002), corresponding to an odds ratio of 2·77 [1·62–4·74] between full exposure (all 6 years) and no exposure.

Interpretation

This study confirms earlier findings that downsizing is associated with health risks. It also shows that repeated exposure to rapid personnel expansion, possibly connected with centralisation of functions, statistically predicts long-term sickness absence and hospital admission. Although no conclusions about causal pathways can be drawn from our results, this exposure should be considered in future studies, policy making, and occupational health care practice.

Introduction

After the economic recession of the early 1990s in Sweden, many workplaces were rapidly downsized—eg, the number of employees was reduced—and reorganised. At the end of the decade, unemployment rates decreased, but were followed by a steep increase in long-term sickness absence, especially in the public sector. In both the public and the scientific debate, this increase in sick leave has frequently been blamed on personnel cuts and overly lean organisations. However, despite the recession, some workplaces grew rapidly during the 1990s, either because of a growing market or because of centralisation of functions. Few, if any, studies with data for individuals have focused on the possible health effects of rapid expansion.

In an explorative study1 using a qualitative classification of a limited number of organisations, all forms of organisational instability, including rapid expansion, were associated with both higher job strain and higher levels of risk factors for coronary heart disease. This finding suggests a general effect of large and prolonged organisational changes. Apart from this study, we have identified no other published study on the health effects of expansion. There is, however, a substantial body of research dedicated to the health effects of downsizing, both on layoff survivors (employees who remain employed in a company after a personnel reduction)2, 3, 4, 5, 6, 7 and those who are laid off (temporary or permanent dismissal from a job).8, 9, 10, 11, 12, 13

We aimed to determine whether accumulated exposure to expansion, downsizing, outsourcing (procurement by a company from outside of parts or services it previously produced, generally leading to a reduction of directly employed personnel), and merging of work organisations is related to risk of subsequent long-term sickness absence and hospital admission.

Section snippets

Participants

Participants were drawn from the biennial Swedish work environment survey, which covers a stratified random sample of the working population. Inclusion criteria were participation in the survey in any of the years 1989, 1991, 1993, 1995, 1997, or 1999, and age younger than 65 years in 1999. 71 506 individuals satisfied the criteria. We excluded 14 617 participants (mostly younger) because they had no data for social class in the 1990 census; 27618 because they were not in employment every

Results

Table 1 shows the descriptive statistics for the participants and table 2 shows the 15 most common combinations of exposures. No one set of exposures predominates, and different combinations of exposures are common, illustrating the vicissitudes of the labour market during the period studied.

Large expansion of workplaces (≥18% per year) was related to an increased risk of long-term sickness absence and hospital admission in the whole study sample (table 3). Moderate downsizing (≥8% and <18% per

Discussion

More and more research has looked at the health effects of downsizing, and our results confirm that corporate downsizing is associated with adverse health outcomes. Our findings, however, showed that repeated exposure to large expansion, possibly in connection with the centralisation of functions, might also be a significant risk factor for long-term sickness absence and hospital admission in individuals with a complete employment record.

We included only individuals who had been working in

References (21)

  • J Vahtera et al.

    Effects of organisational downsizing on health of employees

    Lancet

    (1997)
  • JE Ferrie et al.

    The health effects of major organisational change and job insecurity

    Soc Sci Med

    (1998)
  • S Westin et al.

    Long-term effects of a factory closure: unemployment and disability during ten years' follow-up

    J Clin Epidemiol

    (1989)
  • Westerlund H, Theorell T, Alfredsson L. Organisational instability and cardiovascular risk factors in white-collar...
  • PA Landsbergis et al.

    The impact of lean production and related new systems of work orgaisation on worker health

    J Occup Health Psychol

    (1999)
  • L Grunberg et al.

    Differences in psychological and physical health among layoff survivors: The effect of layoff contact

    J Occup Health Psychol

    (2001)
  • M Kivimäki et al.

    Organisational downsizing and musculoskeletal problems in employees: a prospective study

    Occup Environ Med

    (2001)
  • S Platt et al.

    Changing labour market conditions and health: a systematic literature review (1993–98)

    (1998)
  • JE Ferrrie et al.

    Employment status and health after privatisation in white collar civil servants: prospective cohort study

    BMJ

    (2001)
  • N Beale et al.

    Job-loss and family morbidity: a study of a factory closure

    J R Coll Gen Pract

    (1985)
There are more references available in the full text version of this article.

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