Relationship between financial distress and mistreatment of workers regarding the COVID-19 prevention measures: A 1-year prospective cohort study.

OBJECTIVE: A substantial number of workers' experience mistreatment in the workplace, impacting workers' health and companies' functioning. Vulnerability of those with lower income has been reported, yet little is known about mistreatment during COVID-19. This study aims to examine whether workers in financial distress are particularly prone to mistreatment at the workplace with reference to pandemic-related infection prevention measures. METHODS: An internet-based, year-long prospective cohort study was conducted from 2020 to 2021. Participants were recruited from workers aged 20 and 65 years and currently employed at baseline. In total, 27 036 were included in the analysis and 18 170 responded to the follow-up survey. The odds ratio (OR) of mistreatment at the workplace regarding COVID-19 associated with the financial condition at baseline was estimated using multilevel logistic regression analysis nested by participant residence. RESULTS: Compared with workers in a comfortable financial condition, those under financial stress showed significantly higher ORs of mistreatment (age- and sex-adjusted model: 2.08, 95% confidence interval [CI] 1.75-2.47, P < .001, model adjusted for socioeconomic factors: 2.14, 95% CI 1.79-2.55, P < .001). CONCLUSION: Workers in financial distress were shown to be vulnerable to mistreatment at work regarding infection prevention measures in the COVID-19 pandemic, underscoring a double burden of poverty and mistreatment. The perspective of vulnerable groups needs to be taken into account when implementing countermeasures against emerging infectious diseases, such as COVID-19. As unfair treatment in the workplace might distort vulnerable employees' reactions to infection control (e.g., hiding infection), financial deprivation should be considered a public health issue.

Association between COVID-19 infection rates by region and implementation of non-pharmaceutical interventions: a cross-sectional study in Japan.

BACKGROUND: During a pandemic, non-pharmaceutical interventions (NPIs) play an important role in protecting oneself and others from infection. There are large regional differences in COVID-19 infection rates in Japan. We hypothesized that the local infection incidence may affect adherence to individual NPIs. METHODS: This cross-sectional study was conducted online among full-time workers in Japan in December 2020. The questionnaire asked the respondents to identify their habits regarding seven common NPIs (wearing masks, washing hands after the bathroom, disinfecting hands when entering indoors, gargling when returning home, ventilating the room, disinfecting or washing hands after touching frequently touched surfaces, carrying alcohol sanitizers when outdoors). RESULTS: A total of 27 036 participants were analyzed. Compared with the region with the lowest infection rate, five of the seven NPIs showed statistically significant trends across regional infection levels, the two exceptions being wearing masks and washing hands after the bathroom. Multivariate adjustment did not change these trends. CONCLUSIONS: This study found that NPIs were more prevalent in regions with higher incidence rates of COVID-19 in Japanese workers. The findings suggest that the implementation of NPIs was influenced not only by personal attributes but also by contextual effects of the local infection level.

Job stress and work from home during the COVID-19 pandemic among Japanese workers: a prospective cohort study.

Objectives: The work style reforms and the coronavirus disease pandemic in Japan have prompted efforts toward teleworking, mainly work from home (WFH). This study aimed to prospectively evaluate the impact of WFH on job stress among Japanese workers. Methods: This online survey-based prospective cohort study was conducted from December 2020 (baseline) to December 2021 (1-year follow-up) using self-administered questionnaires. At baseline, 27,036 participants completed the questionnaires, whereas 18,560 (68.7%) participated in the 1-year follow-up. After excluding the 11,604 participants who left or changed workplaces within 1 year or who were physical laborers and hospitality workers, data from 6,956 participants were analyzed. We asked participants about WFH frequency at baseline and conducted a follow-up using the Brief Job Stress Questionnaire (BJSQ). Participants were divided into four groups according to WFH frequency. The odds ratios of poor states of the association of the four subscales (job demand, job control, supervisor support, and coworker support) determined by the BJSQ with WFH frequency were estimated using a multilevel logistic model. Results: In both the gender-age adjusted and multivariate models, compared to the non-WFH group, the medium and low WFH groups were less likely to have poor job control, whereas the high WFH group were likely to have similar levels as the non-WFH group. In both models, compared to non-WFH participants, the high WFH group were more likely to have poor supervisor and coworker support. Conclusions: High-frequency WFH requires further attention, because it may increase job stress by exacerbating deficits of social support in the workplace. Medium- and low-frequency WFH workers were more likely to have satisfactory job control; therefore, limiting WFH to three or fewer days per week may lead to better job stress management.

Relationship between Psychological Distress and Poverty among Japanese Workers during the COVID-19 Pandemic: A Prospective Cohort Study.

OBJECTIVE: This study aimed to examine the relationship between psychological distress and poverty among Japanese workers during the COVID-19 pandemic. METHOD: An internet based prospective cohort study was conducted. A total of 11,081 individuals who were not experiencing poverty at baseline in December 2020 were included. The exposure variable was psychological distress evaluated using the Kessler 6 scale at baseline. The outcome variable was whether participants were experiencing poverty at the one-year follow-up, as defined by household financial distress. RESULT: Compared to individuals without psychological distress, the adjusted odds ratios of household financial distress among those with mild and severe psychological distress were 2.88 (95% CI: 2.47-3.33, p < 0.001) and 3.19 (95% CI: 2.52-4.04, p < 0.001), respectively. CONCLUSION: Workers' psychological distress is a notable public health concern in the context of poverty.

Association of alcohol consumption and frequency with loneliness: A cross-sectional study among Japanese workers during the COVID-19 pandemic.

Background: There are increasing concerns that prevention measures against coronavirus disease 2019 (COVID-19) such as social distancing and telework are leading to loneliness and poor lifestyle habits like increased alcohol consumption. The purpose of this study was to assess whether loneliness reported among workers during the COVID-19 pandemic is associated with changes in alcohol consumption. Methods: The study comprised a cross-sectional, online survey of 27,036 workers between December 22 and 26, 2020. A questionnaire was used to assess loneliness, usual alcohol consumption and whether that consumption had changed. Odds ratios (ORs) were estimated by logistic regression analysis. Results: A total of 2831 (10.5%) workers indicated they had increased alcohol consumption during the pandemic. Increased alcohol consumption was significantly associated with loneliness (OR = 1.94, 95%CI 1.70-2.21). This association held true for those who indicated they drank two or more days per week (OR = 1.98 95%CI 1.71-2.30) and those who drank less than one day per week (OR = 1.51 95%CI 0.71-3.25). In contrast, there was no association between increased alcohol consumption and loneliness among those who indicated they hardly ever drank (OR = 1.22 95%CI 0.55-2.72). Conclusions: Among those drinking more than once a week, increased alcohol consumption is associated with loneliness.

Effect of working place infection control practices on workers' psychological distress: A large-scale cohort study during the COVID-19 pandemic in Japan

Background The COVID-19 pandemic has dramatically transformed the work environment and practices worldwide. Long-term infection control practices may increase the psychological distress of workers, and, conversely, inadequate infection control practices in the working place may increase the fear of infection. This study aimed to determine the relationship between infection control practices in the working place and employee mental state during the COVID-19 pandemic in Japan. Methods This study was conducted in December 2020 and February 2021. The participants had undergone a preliminary survey, which revealed that they were in a good mental state. Their psychological distress was investigated via a second survey, and the factors associated with distress were studied using a logistic model. Results The results of the second survey indicated that 15.3% of participants demonstrated psychological distress. This was associated with leave-of-absence instructions, instructions for shortening business hours, and requests to avoid the working place in case of any symptoms. Conclusion The study found that while some infection control practices reduce workers' distress, others worsen it. Employers need to consider infection control practices as well as the worsening mental state of employees following a decrease in income caused by such measures. Follow-up studies may be necessary to clarify the long-term effects on workers' mental states.

Spread of infection and treatment interruption among Japanese workers during the COVID-19 pandemic: A cross-sectional study.

Background: The COVID-19 pandemic has resulted in treatment interruption for chronic diseases. The scale of COVID-19 in Japan has varied greatly in terms of the scale of infection and the speed of spread depending on the region. This study aimed to examine the relationship between local infection level and treatment interruption among Japanese workers. Methods: Cross-sectional internet survey was conducted from December 22 to 26, 2020. Of 33,302 participants, 9,510 (5,392 males and 4,118 females) who responded that they required regular treatment were included in the analysis. The infection level in each participant's prefecture of residence was assessed based on the incidence rate (per 1,000 population) and the number of people infected. Age-sex and multivariate adjusted odds ratios (ORs) of regional infection levels associated with treatment interruption were estimated by multilevel logistic models, nested by prefecture of residence. The multivariate model was adjusted for sex, age, marital status, equivalent household income, educational level, occupation, self-rated health status and anxiety. Results: The ORs of treatment interruption for the lowest and highest levels of infection in the region were 1.32 [95 % confidence interval (CI) were 1.09-1.59] for the overall morbidity rate (per 1,000) and 1.34 (95 % CI 1.10-1.63) for the overall number of people infected. Higher local infection levels were linked to a greater number of workers experiencing treatment interruption. Conclusions: Higher local infection levels were linked to more workers experiencing treatment interruption. Our results suggest that apart from individual characteristics such as socioeconomic and health status, treatment interruption during the pandemic is also subject to contextual effects related to regional infection levels. Preventing community spread of COVID-19 may thus protect individuals from indirect effects of the pandemic, such as treatment interruption.

A Prospective Cohort Study of Presenteeism and Increased Risk of Divorce Among Japanese Workers.

OBJECTIVE: We examined the association between the presenteeism and the risk of divorce among Japanese workers during the COVID-19 pandemic. METHODS: A prospective study of 27,036 individuals was conducted starting in December 2020, with 18,560 (68.7%) participating in the follow-up in December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment. RESULTS: Compared with the group with the lowest WFun score, the odds ratio for the group with moderate WFun was 1.16 (95% confidence interval, 0.74 to 1.82; P = 0.525), and the odds ratio for the group with the highest WFun was 1.76 (95% confidence interval, 1.18 to 2.62; P = 0.006). CONCLUSIONS: This study suggests that supporting workers with presenteeism has important implications not only from the perspective of labor productivity in management but also for the individual's quality of life in terms of family relationships.

Workplace infection prevention control measures and work engagement during the COVID-19 pandemic among Japanese workers: A prospective cohort study.

OBJECTIVES: Our objective was to assess the effect of appropriate workplace IPC measures on employees' work engagement. It could be important to note how workplace infection prevention control (IPC) measures for COVID-19 contribute to positive mental health among workers. We hypothesized that if workplace IPC measures are adequately implemented, they would have a positive effect on employees' work engagement. METHODS: We conducted an internet-based prospective cohort study from December 2020 (baseline) to December 2021 (follow-up after 1 year) using self-administered questionnaires. At baseline, 27036 workers completed the questionnaires, while 18 560 (68.7%) participated in the one-year follow-up. After excluding the 6578 participants who changed jobs or retired during the survey period, or telecommuted more than 4 days per week, 11 982 participants were analyzed. We asked participants about the implementation of workplace IPC measures at baseline and conducted a follow-up using a nine-item version of the Utrecht Work Engagement Scale (UWES-9). RESULTS: Four groups were created according to the number of workplace IPC measures implemented. The mean (SD) UWES-9 score of the "0-2" group was the lowest at 18.3 (13.2), while that of the "8" group was the highest at 22.6 (12.6). The scores of the "3-5," "6-7," and "8" groups were significantly higher than that of the "0-2" group (all, p < .001). The p trend of the four groups was also significant (p < .001). CONCLUSIONS: Promoting workplace IPC measures improves workers' work engagement, and a dose-response relationship exists between workplace IPC measures and work engagement.

Study Protocol and Preliminary Results of the Impact of Occupational Health Workers' Activities on Their Health: Nationwide Prospective Internet-Based Survey.

BACKGROUND: Owing to the impact of the COVID-19 pandemic, work environments and systems, as well as occupational health measures or activities that fall within our research field, are constantly changing. It is necessary to assess the impact of these changes on the physical and mental health of workers. OBJECTIVE: To assess how occupational health measures affect the health of workers, we conducted a baseline, longitudinal internet-based survey among Japanese workers in October 2021 and additionally scheduled 2 follow-up surveys for 2022 and 2023. We describe the details of the protocol of the work systems and health internet research (WSHIR) study, provide an overview of the results of the baseline survey, and discuss the study procedures and data used in the study. METHODS: This prospective cohort study was conducted online among internet monitors. The baseline survey was conducted from October 1 to 7, 2021. This study targeted those who were working and between the ages of 20 and 69 years. A total of 5111 respondents who passed the screening survey and proceeded to the main survey were enrolled according to collection units organized by sex and age. For the screening and main surveys, the questionnaire consisted of 9 and 33 items with 9 and 55 questions, respectively. Consistency and completeness checks were performed after the questionnaires were submitted. We compared basic characteristics, such as sex, age group, educational background, and marital status, among all participants, including those who withdrew from the analysis. RESULTS: Of the 5111 initial survey respondents, 571 (11.2%) were considered fraudulent. The data of the remaining 4540 (88.8%) participants (2273, 50.1%, males; 2267, 49.9%, females) included in the analysis were well balanced across participant sex and age groups according to the sampling plan because there was no significant difference by sex and age group using the chi-square test for checking the distribution bias of the participants (P=.84). Compared to female participants, male participants tended to be more likely to be managers and supervisors (323, 14.2%, males; 86, 3.8%, females), to work in a secondary industry (742, 32.6%, males; 357, 15.7%, females), and to have an annual income of ≥5 million yen (976, 42.9%, males; 429, 18.9%, females). For the evaluation of a psychological indicator, Kessler 6 (K6) score, by sex and age group, the characteristics of the score distribution of the included participants were similar to those reported in previous studies. CONCLUSIONS: This study presents a protocol and overview of the results of an internet-based occupational health survey of workers. Using the results of this survey, we hope to evaluate the changes in occupational health activities and their impact on workers' health while controlling for the COVID-19 pandemic.

A prospective cohort study of presenteeism and poverty among Japanese workers during the COVID-19 pandemic.

OBJECTIVES: This study examined the association of presenteeism with experiences of poverty among Japanese workers during the COVID-19 pandemic. METHODS: A prospective cohort study of Japanese workers was conducted using an Internet monitoring survey. The baseline survey was conducted in December 2020, and a follow-up survey in December 2021. Of the 27 036 workers who participated, 18 560 (68.7%) completed the follow-up survey. The 11 081 who reported that they were not in financial difficulty in the baseline survey were included in the analysis. The degree of work functioning impairment was assessed at baseline using the Work Functioning Impairment Scale (WFun). Households' experience of not being able to pay for food and clothing was identified in the follow-up survey. The odds ratios (ORs) of presenteeism determined by WFun associated with poverty were estimated using a multilevel logistic model. The multivariate model included age, sex, marital status, job type, income, education, smoking, alcohol consumption, number of employees in the workplace, and the incidence rate of COVID-19 by prefecture at baseline. RESULTS: In the multivariate model, the odds ratio of experiencing food insecurity increased with high WFun score: compared with WFun scores of 13 or less, the OR was 1.87 (95% CI: 1.43-2.43, P < .001) for WFun scores of 14 or more and 3.26 (95% CI: 2.58-4.12, P < .001) for WFun scores of 21 or more. CONCLUSIONS: In addition to labor productivity, the adverse effects of presenteeism on social security-related concerns such as poverty require further attention.

Gender differences in housework and childcare among Japanese workers during the COVID-19 pandemic.

OBJECTIVES: Although gender stereotypes regarding paid work and unpaid work are changing, most wives are responsible for taking care of the family and home in Japan. It is unclear how time spent on housework and childcare has changed between working men and women during the COVID-19 pandemic in Japan. The purpose of this study is to investigate how working men and women's responsibilities for housework and childcare changed during the COVID-19 pandemic in Japan depending on work hours, job type, the number of employees in the workplace, and frequency of telecommuting. METHODS: A cross-sectional analysis (N = 14,454) was conducted using data from an Internet monitoring study (CORoNa Work Project), which was conducted in December 2020. A multilevel logistic model with nested prefectures of residence was conducted to estimate the odds ratio (OR) for change in time devoted to housework and childcare among men and women adjusting for age, household income, presence of spouse who work, work hours, job type, the number of employees in the workplace, frequency of telecommuting, and the incidence rate of COVID-19 by prefecture. RESULTS: More women tended to perceive that their time of housework and/or childcare had been changed (increased housework: OR 1.92, 95% CI [1.71-2.16], P < .001; decreased workhours: 1.66 (1.25-2.19), P < .001: increased childcare: OR 1.58, 95% CI [1.29-1.92], P < .001; decreased childcare: 1.11 (0.62-2.00), P = .719). CONCLUSIONS: The time spent by women on housework and childcare changed significantly compared to men during the COVID-19 pandemic in Japan.

Prospective Cohort Study of Sociodemographic and Work-Related Factors and Subsequent Unemployment under COVID-19 Pandemic.

The previous studies found that women and low-income households were more likely to experience unemployment prior to the COVID-19 pandemic. However, there is no cohort study to examine the relationship during the COVID-19 pandemic. The aim of this prospective cohort study is to examine the relationship between sociodemographic factors and unemployment during the COVID-19 pandemic in Japan. We surveyed the socioeconomic status, personal characteristics, and occupation of recruited workers at baseline (22-25 December 2020); subsequent unemployment was examined at follow-up (18-19 February 2021). We determined the odds ratio of unemployment by sociodemographic status and occupation. The multivariate model was adjusted for sex and age. Among the 19,941 participants, 725 (3.6%) had experienced unemployment. Multivariate analysis showed significant high unemployment amongst women and participants of younger age, bereaved or divorced, unmarried, of lower income, or with short educational background. By occupation, the unemployment rate of temporary or contract employees and self-employed is high. COVID-19 expelled socially vulnerable groups from employment. This suggests the need for employment and economic support for such individuals.

Association between Long Working Hours and Psychological Distress: The Effect Modification by Request to Stay Home When Sick in the Workplace during the COVID-19 Pandemic.

The effect of workplace infection control measures required by the COVID-19 pandemic on the association between long working hours and psychological distress has not yet been fully revealed. This study investigated the effect of requesting to stay home when sick (RSH) on the association between long working hours and psychological distress. We conducted a cross-sectional survey in December 2020 among participants who had previously registered with a Japanese web survey company. A total of 27,036 workers completed a self-administered questionnaire which assessed usual daily overtime work hours. RSH was assessed using an original single-item scale, while psychological distress was measured with the K6 scale. After the interaction effect of overtime work hours and RSH on psychological distress was tested, we conducted stratified analyses using RSH. The statistical analysis demonstrated a significant interaction effect (p for interaction < 0.001). When we conducted stratified analyses, the odds ratios increased with longer working hours, both with and without RSH groups; however, the risk of long working hours causing psychological distress was greater in the latter group (odds ratio = 1.95 [95% confidence interval: 1.62-2.36] than in the former group (odds ratio = 1.73 [95% confidence interval: 1.55-1.93]). We found that working without RSH could strengthen the association between long working hours and psychological distress. Our findings contribute to preventing the deterioration of mental health during the COVID-19 pandemic.

Relationship between alcohol consumption and telecommuting preference-practice mismatch during the COVID-19 pandemic.

OBJECTIVE: This study examined the association between increased alcohol consumption and telecommuting, comparing employees who expressed a preference for telecommuting and those who did not. METHODS: We conducted an internet monitor survey. Responses from 20 395 of the 33 302 participants were included in the final sample. Participants were asked about their desire for and frequency of telecommuting, and about changes in alcohol consumption under the COVID-19 pandemic. Data were analyzed by logistic regression analysis. RESULTS: The ratio of increased drinking in those who telecommuted at least once a week was significantly different (OR = 1.29, 95% CI 1.16-1.43, p < .001). The ratio of increased drinking in participants for whom telecommuting was not preferred was significantly different (OR = 1.08, 95%CI 1.02-1.14, p = .002). Since the interaction term was significant in preliminary analysis, stratification was performed. Participants who telecommuted despite preferring not to do so reported significantly increased alcohol consumption, as revealed by a multivariate analysis (OR = 1.53, 95% CI 1.18-2.00, p < .001). Participants who expressed a preference for telecommuting showed no such increase (OR = 1.12, 95% CI 0.98-1.27, p = .074). CONCLUSIONS: Under the COVID-19 pandemic, telecommuting that involves a mismatch with employee preference for way of working may be a new risk factor for problematic drinking.

Association Between Loneliness and Sleep-Related Problems Among Japanese Workers During the COVID-19 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has been linked to a rise in loneliness. Loneliness is associated with sleep-related problems, which in turn can be a risk factor for various psychiatric disorders. However, it is unclear whether loneliness is linked to sleep-related problems during the pandemic. Here, we studied the association between loneliness and sleep-related problems during the COVID-19 pandemic in Japan. Methods: A total of 33,302 individuals who indicated they were employed were surveyed online. The survey responses of 27,036 participants were analyzed. Odds ratios (ORs) were estimated using univariate and multiple logistic regression analyses. Results: Of those analyzed, 2,750 (10.2%) experienced feelings of loneliness. Further, sleep-related problems were significantly more common among those who felt lonely both in the short term (more than 3 days) and the long term (more than 3 months). The ORs were much weaker after adjusting for factors related to interpersonal connections, such as family and friendships, than after adjusting for factors related to socioeconomic status. Conclusion: Loneliness may be a risk factor for sleep-related problems in the COVID-19 pandemic. Having connections with family and friends may have a moderating effect on the occurrence of sleep-related problems.

Association between Long Working Hours and Psychological Distress: The Effect Modification by Request to Stay Home When Sick in the Workplace during the COVID-19 Pandemic

The effect of workplace infection control measures required by the COVID-19 pandemic on the association between long working hours and psychological distress has not yet been fully revealed. This study investigated the effect of requesting to stay home when sick (RSH) on the association between long working hours and psychological distress. We conducted a cross-sectional survey in December 2020 among participants who had previously registered with a Japanese web survey company. A total of 27,036 workers completed a self-administered questionnaire which assessed usual daily overtime work hours. RSH was assessed using an original single-item scale, while psychological distress was measured with the K6 scale. After the interaction effect of overtime work hours and RSH on psychological distress was tested, we conducted stratified analyses using RSH. The statistical analysis demonstrated a significant interaction effect (p for interaction < 0.001). When we conducted stratified analyses, the odds ratios increased with longer working hours, both with and without RSH groups;however, the risk of long working hours causing psychological distress was greater in the latter group (odds ratio = 1.95 [95% confidence interval: 1.62–2.36] than in the former group (odds ratio = 1.73 [95% confidence interval: 1.55–1.93]). We found that working without RSH could strengthen the association between long working hours and psychological distress. Our findings contribute to preventing the deterioration of mental health during the COVID-19 pandemic.

A Cross-Sectional Study of the Relationship Between Exercise, Physical Activity, and Health-Related Quality of Life Among Japanese Workers.

Background: Studies have determined that exercise and physical activity positively affect physical and mental health, and that healthy workers contribute to increased work performance. The relationship between the time spent on exercise during leisure time and physical activity, including work, with health-related quality of life (HRQOL) in workers is unclear, with variations observed between occupational types. This cross-sectional study examined these associations among Japanese workers from various occupations during the COVID-19 pandemic. Methods: An Internet-based national health survey-Collaborative Online Research on Novel-coronavirus and Work-study (CORoNaWork study)-was conducted among 33,087 Japanese workers in December 2020. After excluding invalid responses, 27,036 participants were categorized into four and five groups according to exercise and physical activity time, respectively. Each group's scores were compared on each of the four questions on the Japanese version of the Centers for Disease Control and Prevention Health-Related Quality of Life (CDC HRQOL-4) using generalized linear models. Age-sex adjusted and multivariate models were used to compare each index of the CDC HRQOL-4. Results: Compared to the reference category (almost never), any level of exercise (ORs 0.56-0.77) and physical activity (ORs 0.93-0.88) were associated with better self-rated health in the multivariate model. Any exercise was also associated with significantly reduced odds for physically or mentally unhealthy days; however, high levels of physical activity (≥120 min/day) were associated with significantly increased odds for these outcomes (ORs = 1.11 and 1.16, respectively). Conclusions: The results suggest that exercise habits are more critical to workers' HRQOL than physical activity. Interventions that encourage daily exercise even for a short time are likely to be associated with better workers' health and work performance.

Prospective cohort study of workers diagnosed with COVID-19 and subsequent unemployment.

OBJECTIVES: The purpose of this study was to investigate the relationships of workers being diagnosed with coronavirus disease 2019 (COVID-19) and being identified as close contacts of infected persons with unemployment in Japan. METHODS: This was a prospective cohort study using questionnaires about COVID-19 administered to Japanese workers. A baseline survey conducted on December 22-25, 2020, was used to determine history of being diagnosed with COVID-19 or being identified as a close contact of an infected person. Unemployment since the baseline survey was ascertained with a follow-up survey on February 18 and 19, 2021. The odds ratios (ORs) of unemployment were estimated using a multilevel logistic model with adjusted covariates nested in prefecture of residence. RESULTS: Women (n = 8771) accounted for 44% of the total sample (n = 19 941), and the mean age was 48.0 years. In terms of unemployment because of negative reasons, the multivariate analysis showed that the OR of unemployment associated with being diagnosed with COVID-19 was 2.40 (95% CI: 1.15-5.01) and that the OR associated with being identified as a close contact was 0.98 (95% CI: 0.31-3.11). CONCLUSIONS: There is an association between workers being diagnosed with COVID-19 and unemployment. The reason is not clear, but if the unemployment is unwanted by the individual, workplace adjustment may help prevent unwilling unemployment.

Treatment interruption is a risk factor for sickness presenteeism: A large-scale cross-sectional study during the COVID-19 pandemic.

OBJECTIVES: This study examined the relationship between interruption to routine medical care during the coronavirus disease 2019 pandemic and sickness presenteeism among workers in Japan. METHODS: A cross-sectional study using data obtained from an internet monitor questionnaire was conducted. Interruption to medical care was defined based on the response "I have not been able to go to the hospital or receive treatment as scheduled." The fraction of sickness presenteeism days in the past 30 days was employed as the primary outcome. A fractional logit model was used for analysis to treat bounded data. RESULTS: Of the 27 036 participants, 17 526 (65%) were workers who did not require routine medical care, 8451 (31%) were using medical care as scheduled, and 1059 (4%) experienced interrupted medical care. The adjusted odds ratio (aOR) of sickness presenteeism was significantly higher among workers who experienced interrupted medical care (3.44; 95% confidence interval [CI]: 3.04-3.89) than those who did not require routine medical care. In terms of symptoms, the highest aOR was observed among workers with mental health symptoms (aOR: 5.59, 95% CI: 5.04-6.20). CONCLUSIONS: This study suggests the importance of continuing necessary treatment during a pandemic to prevent presenteeism.