ArticlesWorkplace expansion, long-term sickness absence, and hospital admission
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.
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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
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