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All-cause and diagnosis-specific sickness absence as a predictor of sustained suboptimal health: a 14-year follow-up in the GAZEL cohort
  1. Jussi Vahtera1,2,
  2. Hugo Westerlund3,
  3. Jane E Ferrie4,
  4. Jenny Head4,
  5. Maria Melchior5,
  6. Archana Singh-Manoux5,
  7. Marie Zins5,
  8. Marcel Goldberg5,
  9. Kristina Alexanderson6,
  10. Mika Kivimäki1,4
  1. 1Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  3. 3Stress Research Institute, Stockholm University, Stockholm, Sweden
  4. 4Department of Epidemiology and Public Health, University College London, London, UK
  5. 5INSERM, Paris, France
  6. 6Karolinska Institutet, Section of Personal Injury Prevention, Stockholm, Sweden
  1. Correspondence to Dr Jussi Vahtera, Finnish Institute of Occupational Health, Lemminkäisenkatu 14–18, Turku FIN-20520, Finland; jussi.vahtera{at}


Background Previous studies show that sickness absence predicts health, but it is unclear whether this association is persistent over time and whether specific diseases underlie long-term associations. The aim of this study was to investigate overall and diagnosis-specific sickness absences as predictors of sustained suboptimal health.

Methods Prospective occupational cohort study of 15 320 employees (73% men) aged 37–51. Sickness absence records in 1990–1992, including 13 diagnostic categories, were examined in relation to self-rated health measured annually for the years 1993–2006.

Results 3385 employees (22%) had >30 days of sickness absence and 5564 (36%) 1–30 days during the 3-year exposure window. Repeated-measures logistic regression analysis adjusted for age, sex, occupational status and chronic diseases show that employees with >30 absence days, compared with those with no absences, had 2.14 (95% CI 2.00 to 2.29) times higher odds for suboptimal health over the 14 years of follow-up. Retirement did not dilute this association. Nine sickness absence diagnostic categories, such as diseases of the nervous, circulatory, metabolic, musculoskeletal, sensory and gastrointestinal systems, cancer, mental disorders and external causes, independently predicted increased risk of sustained suboptimal health.

Conclusions There is a remarkably persistent association between sickness absence and future long-term self-rated health status for the majority of diagnostic categories for sickness absence. This suggests that the association between sickness absence and health is ubiquitous and not driven by a limited number of rare and severe diseases.

  • Sickness absence
  • self-rated health
  • longitudinal
  • multilevel
  • occupational
  • longitudinal studies
  • multilevel modelling

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  • Funding JV and MK are supported by the Academy of Finland (grant no 117604, no 124271 and no 124322), HW is supported by the Swedish Council for Working Life and Social Research (FAS, grant no 2004-2021, no 2007-1143). JEF is supported by the MRC (grant no G8802774). AS-M is supported by a EUYRI award from the European Science Foundation. KA was supported by the Swedish Council for Working Life and Social Research.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the INSERM, France.

  • Provenance and peer review Not commissioned; externally peer reviewed.