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Changes in drinking as predictors of changes in sickness absence: a case-crossover study
  1. Jenni Ervasti1,
  2. Mika Kivimäki1,2,3,
  3. Jaana Pentti3,
  4. Jaana I Halonen1,
  5. Jussi Vahtera4,
  6. Marianna Virtanen1
  1. 1 Research and Service Centre for Occupational Health, Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2 Department of Epidemiology and Public Health, University College London, London, UK
  3. 3 Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  4. 4 Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  1. Correspondence to Dr Jenni Ervasti, Finnish Institute of Occupational Health, PB 18, FI-00032 TYÖTERVEYSLAITOS, Finland; jenni.ervasti{at}


Background We investigated whether changes in alcohol use predict changes in the risk of sickness absence in a case-crossover design.

Methods Finnish public sector employees were surveyed in 2000, 2004 and 2008 on alcohol use and covariates. Heavy drinking was defined as either a weekly intake that exceeded recommendations (12 units for women; 23 for men) or having an extreme drinking session. The responses were linked to national sickness absence registers. We analysed the within-person relative risk of change in the risk of sickness absence in relation to change in drinking. Case period refers to being sickness absent within 1 year of the survey and control period refers to not being sickness absent within 1 year of the survey.

Results Periods of heavy drinking were associated with increased odds of self-certified short-term (1–3 days) sickness absence (multivariable-adjusted OR 1.21, 95% CI 1.07 to 1.38 for all participants; 1.62, 95% CI 1.19 to 2.21 for men and 1.15, 95% CI 1.00 to 1.33 for women). A higher risk of short-term sickness absence was also observed after increase in drinking (OR=1.27, 95% CI 1.07 to 1.52) and a lower risk was observed after decrease in drinking (OR=0.83, 95% CI 0.69 to 1.00). Both increase (OR=1.38, 95% CI 1.21 to 1.57) and decrease (OR=1.27, 95% CI 1.19 to 1.43) in drinking were associated with increased risk of long-term (>9 days) medically certified all-cause sickness absence.

Conclusion Increase in drinking was related to increases in short-term and long-term sickness absences. Men and employees with a low socioeconomic position in particular seemed to be at risk.

  • alcohol intake
  • case-crossover design
  • Finland
  • injury
  • mental health
  • poisoning
  • occupational position
  • sex differences
  • sickness absence
  • socioeconomic gradient

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  • Contributors JE, MK, JV, JP and MV contributed to conception and design. JE analysed the data and drafted the manuscript. JP contributed to analysis, and MK, JV, JIH and MV to interpretation and to critically revising the manuscript. All gave final approval and agree to be accountable for all aspects ensuring integrity and accuracy.

  • Funding JE and MV received funding from the Academy of Finland (#292824, #258598). MK is supported by the NordForsk (the Nordic Programme on Health and Welfare), and JV received funding from the Academy of Finland (#264944 and #267727).

  • Competing interests None declared.

  • Ethics approval Ethics committee of the Hospital District of Helsinki.

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