Long-term sickness absence of 32 chronic conditions: a Danish register-based longitudinal study with up to 17 years of follow-up.

OBJECTIVES: Sickness absence has been used as a central indicator of work disability, but has mainly been examined in single diseases, with limited follow-up time. This study identified the risk of long-term sickness absence (LTSA) of 32 chronic disease groups in the first year after diagnosis and the subsequent years. SETTING: We identified chronic disease groups prevalent in the work force (26 physical and 6 mental conditions) requiring all levels of care (primary, secondary, tertiary), by national registers of diagnoses from all hospital visits and prescribed medicine in Denmark from 1994 to 2011. PARTICIPANTS: A general population sample within the working age range (18-59 years) was drawn by Statistics Denmark. Participants not working before and during the follow-up period were excluded. A total of 102 746 participants were included. PRIMARY AND SECONDARY OUTCOME MEASURES: HRs of transitions from work to LTSA of each of the chronic conditions were estimated in Cox proportional hazards models for repeated events-distinguishing between risk within the first (<1 year) and subsequent years of diagnosis (≥1 year) and an HR ratio (HRR): HR ≥1 year divided by HR <1 year. RESULTS: Almost all the conditions were associated with significantly increased risks of LTSA over time. The risks were generally more increased in men than in women. Three main patterns of LTSA were identified across diseases: strong decreases of LTSA from the first to subsequent years (eg, stroke in men <1 year: HR=7.55, 95% CI 6.45 to 8.85; ≥1 year HR=1.43, 95% CI 1.20 to 1.74; HRR=0.23). Moderate or small decreases in LTSA (HRR between 0.46 and 0.76). No changes (HRR between 0.92 and 0.95) or increases in elevated risks of LTSA over time (HRR between 1.02 and 1.16). CONCLUSIONS: The 32 chronic diseases were associated with three different risk patterns of LTSA over time. These patterns implicate different strategies for managing work disability over time.

Effect of Rheumatoid Arthritis on Longterm Sickness Absence in 1994-2011: A Danish Cohort Study.

OBJECTIVE: By linkage of national registries, we investigated the risk of longterm sickness absence (LTSA) ≥ 3 weeks in a large cohort of Danish patients with rheumatoid arthritis (RA) and non-patients. The study aimed to (1) estimate the risk of LTSA for patients with RA compared with the general population, (2) examine whether the risk of LTSA has changed in recent years, and (3) evaluate the effect of other risk factors for LTSA (e.g., physical work demands, age, sex, education, and psychiatric and somatic comorbidities). METHODS: A total of 6677 patients with RA aged 18-59 years in the years 1994-2011 were identified in registries and compared with 56,955 controls from the general population matched by age, sex, and city size. The risk of LTSA was analyzed using Cox proportional hazards models with late entry, controlling for other risk factors and assuming separate risks in the first year after diagnosis and the following years. RESULTS: Compared with the general population, patients with RA had increased risk of LTSA in the first year after diagnosis (HR 5.4 during 1994-1999, 95% CI 4.2-6.8) and in following years (HR 2.4, 95% CI 2.1-2.8). For established RA (> 1 yr after diagnosis), the excess was 20% lower in 2006-2011 (HR 1.9, 95% CI 1.7-2.2) compared with 1994-1999 (p < 0.001). For patients with RA and controls, older age, shorter education, a physically demanding job, and somatic and/or psychiatric comorbidities increased the risk of LTSA. CONCLUSION: While improvements were observed from 1994-1999 to 2006-2011, patients with RA have significant increased risk of LTSA, in particular in the first year after diagnosis.

Why do people with suboptimal health avoid health promotion at work?

OBJECTIVES: To explore why people who have active work and who experience suboptimal health avoided using a multipurpose in-house health promotion service in the Danish police. METHODS: Data were first collected via an electronic survey (N=6060) and subsequently via 25 telephone interviews targeting nonusers who perceived their health to be suboptimal. RESULTS: Many nonusers with suboptimal health wished to change health behaviors, but did not use the service. Reasons were both individual (eg, laziness) and organizational (eg, delivery of the service). CONCLUSIONS: Although many reported barriers are more individual in nature, increased information and accessibility could serve to increase participation.

Implementation of self-rostering (the PRIO-project): effects on working hours, recovery, and health.

OBJECTIVES: The aim of this study was to (i) investigate the consequences of self-rostering for working hours, recovery, and health, and (ii) elucidate the mechanisms through which recovery and health are affected. METHODS: Twenty eight workplaces were allocated to either an intervention or reference group. Intervention A encompassed the possibility to specify preferences for starting time and length of shift down to 15 minutes intervals. Interventions B and C included the opportunity to choose between a number of predefined duties. Questionnaires (N=840) on recovery and health and objective workplace reports of working hours (N=718) were obtained at baseline and 12 months later. The interaction term between intervention and time was tested in mixed models and multinomial logistic regression models. RESULTS: The odds ratio (OR) of having short [OR 4.8, 95 % confidence interval (95% CI) 1.9-12.3] and long (OR 4.8, 95% CI 2.9-8.0) shifts increased in intervention A. Somatic symptoms (ß= -0.10, 95% CI -0.19- -0.02) and mental distress (ß= -0.13, 95% CI -0.23- -0.03) decreased, and sleep (ß= 1.7, 95% CI 0.04-0.30) improved in intervention B, and need for recovery was reduced in interventions A (ß= -0.17, 95% CI -0.29- -0.04) and B (ß= -0.17, 95% CI -0.27- -0.07). There were no effects on recovery and health in intervention C, and overall, there were no detrimental effects on recovery or health. The benefits of the intervention were not related to changes in working hours and did not differ by gender, age, family type, degree of employment, or working hour arrangements. CONCLUSIONS: After implementation of self-rostering, employees changed shift length and timing but did not compromise most recommendations for acceptable shift work schedules. Positive consequences of self-rostering for recovery and health were observed, particularly in intervention B where worktime control increased but less extensively than intervention A. The effect could not be statistically explained by changes in actual working hours.