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All-cause and diagnosis-specific sickness absence as a predictor of sustained sub-optimal health: a 14-year follow-up in the GAZEL cohort
  1. Jussi Vahtera1,
  2. Hugo Westerlund2,
  3. Jane E Ferrie3,
  4. Jenny Head4,
  5. Maria Melchior5,
  6. Archana Singh-Manoux5,
  7. Marie Zins5,
  8. Marcel Goldberg5,
  9. Kristina Alexanderson6,
  10. Mika Kivimaki4
  1. 1 Finnish Institute of Occupational Health, Finland;
  2. 2 Stockholm University, Sweden;
  3. 3 UCL, United Kingdom;
  4. 4 University College London, United Kingdom;
  5. 5 INSERM, France;
  6. 6 Karolinska Institutet, France
  1. * Corresponding author; email: 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 sub-optimal health.

Methods: Prospective occupational cohort study of 15,320 employees (73% men) aged 37 to 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: 3,385 employees (22%) had >30 days of sickness absence and 5,564 (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 employees with >30 absence days, compared to those with no absences, had 2.14 (95% CI 2.00-2.29) times higher odds for suboptimal health over the 14 years of follow-up. Retirement did not dilute this association. 9 sickness absence diagnostic categories, such as diseases of the nervous, circulatory, metabolic, musculoskeletal, sensory and gastro-intestinal systems, cancer, mental disorders and external causes, independently predicted increased risk of sustained sub-optimal 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.

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