Objectives To assess the relative importance of occupational physical activities, conditions of employment and culturally determined health behaviour as determinants of sickness absence for musculoskeletal disorders, we compared patterns of absence in three categories of worker (nurses, office workers and manual workers) from culturally diverse countries.
Methods The standardised CUPID questionnaire was used to collect data on sickness absence in the past year from 9347 workers in 31 occupational groups from 13 countries.
Results The 1-year prevalence of sickness absence for musculoskeletal illness ranged from 3% in Japanese nurses and 6% in Japanese manual workers to 49% in Italian manual workers (in a toy factory). Rates for non-musculoskeletal disorders varied from 3% in Brazilian cane cutters to 70% in UK nurses and 73% in New Zealand postal workers. The ratio of the prevalence of absence attributed to musculoskeletal illness to that for non-musculoskeletal disorders varied more than 35-fold from 0.15 in Japanese nurses to 5.33 in Brazilian cane cutters. In general it was higher in nurses than in office workers from the same country, and more variable in manual workers than in the other occupational groups.
Conclusions The large differences between occupational groups in the attribution of sickness absence to musculoskeletal as compared with other disorders are unlikely to be explained entirely by differences in the physical demands of work and in employment conditions. They may also be importantly influenced by culturally determined differences in health behaviours.