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Socioeconomic differences in health check-ups and medically certified sickness absence: a 10-year follow-up among middle-aged municipal employees in Finland
  1. Kustaa Piha,
  2. Hilla Sumanen,
  3. Eero Lahelma,
  4. Ossi Rahkonen
  1. Department of Public Health, University of Helsinki, Helsinki, Finland
  1. Correspondence to Dr Kustaa Piha, Department of Public Health, University of Helsinki, P.O. Box 20, Helsinki FIN-00014, Finland; Kustaa.Piha{at}


Background There is contradictory evidence on the association between health check-ups and future morbidity. Among the general population, those with high socioeconomic position participate more often in health check-ups. The main aims of this study were to analyse if attendance to health check-ups are socioeconomically patterned and affect sickness absence over a 10-year follow-up.

Methods This register-based follow-up study included municipal employees of the City of Helsinki. 13 037 employees were invited to age-based health check-up during 2000–2002, with a 62% attendance rate. Education, occupational class and individual income were used to measure socioeconomic position. Medically certified sickness absence of 4 days or more was measured and controlled for at the baseline and used as an outcome over follow-up. The mean follow-up time was 7.5 years. Poisson regression was used.

Results Men and employees with lower socioeconomic position participated more actively in health check-ups. Among women, non-attendance to health check-up predicted higher sickness absence during follow-up (relative risk =1.26, 95% CI 1.17 to 1.37) in the fully adjusted model. Health check-ups were not effective in reducing socioeconomic differences in sickness absence.

Conclusions Age-based health check-ups reduced subsequent sickness absence and should be promoted. Attendance to health check-ups should be as high as possible. Contextual factors need to be taken into account when applying the results in interventions in other settings.


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  • Contributors All the authors developed the research questions and planned the analyses. KP, EL and OR acquired the data. KP conducted the analyses. KP drafted the manuscript, and all the authors revised it critically. KP is the guarantor.

  • Competing interests None declared.

  • Ethics approval This study was conducted with the approval of the ethics committee of the Department of Public Health at the University of Helsinki and the City of Helsinki Health Authorities.

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