Determinants of high annual sickness absence in older workers: a prospective cohort study in England (Health and Employment After Fifty study)
Stefania D’Angelo, Georgia Ntani, Elena Zaballa, Ira Madan, David CoggonObjectives
To quantify contributions of health- and employment-related risk factors to high annual sickness absence (HASA) among a population-based cohort of older workers in England.
Design
Prospective cohort study.
Setting
24 general practices geographically dispersed across England.
Participants
Men and women initially aged 50–64 years recruited as part of the Health and Employment After Fifty study.
Primary and secondary outcome measures
HASA, defined as a total of more than 20 days sickness absence over a 12-month interval.
Results
4726 men and women were analysed, providing data on 15 333 12-month follow-up intervals. HASA was reported in 1003 (6.5%) follow-up intervals. In adjusted models, the aspects of health with the largest population-attributable fractions (PAFs) % were disabling musculoskeletal pain (25.4, 95% CI 21.2 to 29.3) and depression (11.3, 95% CI 6.1 to 16.2). Among long-term determinants of health, high body mass index had the greatest impact (PAF% 18.2, 95% CI 8.9 to 26.5). After allowance for health, high physical demands of work (PAF% 22.8) and eligibility for more generous sick pay (PAF% 25.8) made substantial contributions.
Conclusions
Strategies to minimise avoidable sickness absence at older ages should prioritise: reversal of recent increases in disabling mental illness; encouragement of continued activity in workers with non-specific musculoskeletal pain, supported by modification of occupational tasks if needed; timely surgery for disabling osteoarthritis; reducing obesity; and increasing opportunities for placement in work that is less demanding physically. Further research is needed to clarify the impacts of generous sick pay on patterns of sickness absence.