Occup Environ Med 60:e9 doi:10.1136/oem.60.9.e9
  • Electronic pages

Downsizing of staff is associated with lowered medically certified sick leave in female employees

  1. T Theorell1,
  2. G Oxenstierna1,
  3. H Westerlund1,
  4. J Ferrie2,
  5. J Hagberg3,
  6. L Alfredsson4
  1. 1Department of Public Health Sciences, Karolinska Institutet, and National Institute for Psychosocial Factors and Health, Stockholm
  2. 2Department of Epidemiology and Public Health, University College London, London
  3. 3Jan Hagberg, Department of Statistics, Stockholm University
  4. 4Institute of Environmental Medicine, Karolinska Institutet, Stockholm
  1. Correspondence to:
 Dr T Theorell, National Institute for Psychosocial Factors and Health, Box 230, Stockholm S-171 77, Sweden; 
  • Accepted 17 April 2003


Aim: To determine whether changes in number of staff in work sites are associated with medically certified sick leave among employees with an increased risk of developing cardiovascular disease.

Methods: The 5720 employees (aged 18–65) were from the WOLF study of cardiovascular risk factors in working men and women in greater Stockholm during the years 1992–95. From the medical examination a cardiovascular score was calculated for each participant. The WOLF study base was linked to a Statistics Sweden registry of economic and administrative activities. Sick leave spells lasting for at least 15 days during the calendar year following downsizing/expansion were identified for each subject.

Results: In multiple logistic regression an increased likelihood of having no medically certified sick leave (15 days or more) was found in women during the year following both downsizing and expansion. These analyses were adjusted for age and cardiovascular score. A high cardiovascular risk score reduced the likelihood of having no medically certified sick leave. The inclusion of psychosocial work environment variables did not change the results markedly. Separate analyses of women with and without high cardiovascular score showed that downsizing had a more pronounced effect on reduced long term sick leave among those with high than among those without low cardiovascular score. There were no consistent findings in men.

Conclusions: There is evidence of a reduction of long term sick leave in women after downsizing and this is particularly evident among those with high cardiovascular score.