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• Authors' reply
  David Gimeno
  Published on: 27 April 2016
• Are sickness absence frequencies in the study of EU countries underestimates?
  Mika Kivimäki
  Published on: 27 April 2016

• Published on: 27 April 2016

  Authors' reply

  • David Gimeno, Postdoctoral fellow
  • Other Contributors:
    • Benjamin C. Amick III, Fernando G. Benavides, and J Benach.

  Dear Editor

  In response to our study,[1] Kivimäki et al suggested that reported sickness absence frequencies were underestimates of the total sickness absence burden in European Union (EU) member countries.[2] This concern about the veracity of these estimates led Kivimäki et al to caution policy makers to not use this data to inform policy. While we agree that more research is needed to establish...

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  Dear Editor

  In response to our study,[1] Kivimäki et al suggested that reported sickness absence frequencies were underestimates of the total sickness absence burden in European Union (EU) member countries.[2] This concern about the veracity of these estimates led Kivimäki et al to caution policy makers to not use this data to inform policy. While we agree that more research is needed to establish potential biases associated with different approaches to ascertain accurate asking sickness absence data, we consider the European Survey on Working Conditions (ESWC) to be useful to inform the cross-national policy debate. Country-specific studies contribute knowledge to the evidence base but cross-national studies such as ours help to provide a stronger basis upon which to make cross-national inferences. Furthermore, cross-national studies become more relevant as data accumulate and the data collection quality improves. We hope that Kivimäki and colleagues are not suggesting the ESWC be discontinued.

  We consider the studies by Kivimäki et al to be some of the most relevant epidemiological studies of sickness absence predictors.[3][4][5] Although informative, these studies raise several issues in the context of cross-national comparisons. First, epidemiological cohorts in Finland and the United Kingdom represent very homogenous and specific working populations (ie municipal employees, hospital workers and civil servants) with unknown generalizability to the national representative surveys studied in our paper or the ones referenced by Kivimäki et al.[6][7] Second, a fundamental advantage of national workforce surveys is the ability to capture all workers, whereas registries may lead to an under representation of marginal work groups typically not included in national registries. Indeed, Kivimäki et al are not arguing that the Finnish and British cohorts are representative of the countries’ workforces. Even so, labor market inequalities may cause temporary and less protected workers to be underrepresented in the type of well-designed cohort studies they have referenced.[8] Temporary and less protected workers are important in the EU economy and lack of knowledge about their labor market experiences as related to sickness absence could lead to their further marginalization in the policy debate. Third, Kivimäki et al criticised the data collection method employed in the ESWC. We are not aware of any cross-national study comparing the reliability, validity and performance of different sickness absence data collection methods. Concerns have been raised about who is placed on a sickness absence registry. Registered data are very conditioned by the country’s social security system criteria for sickness absence, which complicates between-countries comparisons.[9] Therefore, whether registries are the gold standard in sickness absence studies remains a point of debate yet to be closed.

  In addition, Kivimäki et al compared our results to two survey based studies from Finland and Britain, but differences in sample selection and questionnaire design between these studies may limit comparisons. Our study included people aged 15 years and older who had any paid job during the reference week, or who had a job but were temporarily absent. The recall period for sickness absence was 12 months. The Finnish study was based on employees aged 25 to 64 using a 6 month recall period for sickness absence.[10] The British survey investigated the psychiatric morbidity prevalence among the British adult population. This study sampled workers aged 16-64 years and excluded workers with a psychosis diagnosis. Workers who were currently working or had been working in the last year were asked to report absence days due to their health or feelings.[11] For these reasons, caution is needed if a direct comparison between these three studies is intended.

  Finally, we agree with Kivimäki et al that potential bias in the ESWC could be present (see page 868-9 in our article). However, we would argue that the best sources of data to inform policy are derived from systematic efforts to collect sickness absence data in a clear and consistent fashion from a representative sample of the labor force within each country. We consider the evidence presented by Kivimäki et al to support our argument of the difficulty in establishing between-country comparisons due to the fragmented and insufficient sickness absence data available at the European Union level. We consider our results useful. Although the results are preliminary and may be subjected to scientific scrutiny, the comparative findings may provoke researchers to develop standards for sickness absence studies to facilitate between-country comparisons. In addition, we hope the observed differences will promote further investigation into root causes of between-country differences, especially between northern and southern EU members, as well as within-country gender differences. We certainly welcome cross-national collaborative efforts among the EU sickness absence researches to address all these issues.

  References

  1. Gimeno D, Benavides FG, Benach J, Amick BC III. Distribution of sickness absence in the European Union countries. Occup Environ Med 2004;61:867-9.

  2. Kivimäki M, Vahtera J, Head J, Ferrie JE. Are sickness absence frequencies in the study of EU countries underestimates? [electronic response to Gimeno D et al. Distribution of sickness absnce in the European Union countries] occenvmed.com 2004 URL direct link to eLetter.

  3. Vahtera J, Pentti J, Kivimäki M. Sickness absence as a predictor of mortality among male and female employees. J Epidemiol Community Health 2004;58:321-6.

  4. Kivimäki M, Virtanen M, Vartia M, Elovainio M, Vahtera J, Keltikangas-Järvinen L. Workplace bullying and the risk of cardiovascular disease and depression. Occup Environ Med 2003;60:779-83.

  5. Kivimäki M, Head J, Ferrie JE, Shipley MJ, Vahtera J, Marmot MG. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ 2003;327:364-8.

  6. Kauppinen T, Hanhela R, Heikkilä P et al. Work and Health in Finland 2003. Finnish Institute of Occupational Health, Helsinki, 2004.

  7. Stansfeld SA, Head J, Rasul F, Singleton N, Lee A. Occupation and mental health: Secondary analyses of the ONS Psychiatric Morbidity Survey of Great Britain. Research Report 168, Health and Safety Executive Books, 2003.

  8. Moss NE. [Review of the book Why Are Some People Healthy and Others Not? The Determinants of Health of Populations, by Robert G. Evans, Morris L. Barer, and Theodore R. Marmot] Health Affairs 1995;(14) 2:318- 21.

  9. Gründemann RWM, van Vuuren CV. Preventing absenteeism at the workplace. Dublin: European Foundation for the Improvement of Living and Working Conditions, 1997

  10. Kauppinen T, Hanhela R, Heikkilä P et al. Work and Health in Finland 2003. Finnish Institute of Occupational Health, Helsinki, 2004.

  11. Stansfeld SA, Head J, Rasul F, Singleton N, Lee A. Occupation and mental health: Secondary analyses of the ONS Psychiatric Morbidity Survey of Great Britain. Research Report 168, Health and Safety Executive Books, 2003.

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  Conflict of Interest:
  None declared.

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• Published on: 27 April 2016

  Are sickness absence frequencies in the study of EU countries underestimates?

  • Mika Kivimäki, Professor
  • Other Contributors:
    • Jussi Vahtera, Jenny Head, and Jane E. Ferrie

  Dear Editor

  The paper by Gimeno et al provides a comparison of sickness absence between 15 European Union (EU) countries.[1] According to this study, 14.5% of employees were absent at least one day in the past 12 months by an accident at work, by health problems caused by the work, or by other health problems. For Finnish employees, for instance, this percentage was 24%, the highest among the 15 EU countr...

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  Dear Editor

  The paper by Gimeno et al provides a comparison of sickness absence between 15 European Union (EU) countries.[1] According to this study, 14.5% of employees were absent at least one day in the past 12 months by an accident at work, by health problems caused by the work, or by other health problems. For Finnish employees, for instance, this percentage was 24%, the highest among the 15 EU countries, and in the UK 11.7%.

  These figures are much lower than those reported previously. A population-based survey of Finnish employed workforce aged 25 to 64 carried out in 2000 found that 45% of employees took sickness absence during the past 6 months.[2] Correspondingly, a population based survey of 5400 British adults aged 15-64 reported that 30% of working adults took time off work in the past year because of their health or feelings.[3]

  Three large cohort studies from Finland and the UK have used absence records instead of self-reports. In 2000, 58% of 77 850 municipal employees participating in the 10-town study[4] took at least one sickness absence day and the same percentage was obtained in the Hospital Personnel Study[5] for 30 864 hospital workers aged 15 to 65. In the Whitehall II study[6] of over 10 000 British civil servants aged 35 to 55, 57% in men and 76% in women recorded sick leave 12 months prior to the study entry in 1985-1988.

  Based on these national studies, we suspect that the figures presented by Gimeno et al are underestimates of actual absence frequency in the EU countries. Data on sickness absence were derived from face-to-face interviews that were carried out at participant's home, a rarely applied assessment strategy for sickness absence. It is possible that the wording of the question led people to report sickness absence only when they believed it to be work related. The authors note that low response rates in some countries and healthy worker effect are potential sources of bias.

  We feel that the data presented by Gimeno et al are far too preliminary to be the basis of any policy at this stage or of conclusions regarding differences in absence frequency between nations. We fully agree with their recommendation for further research on sickness absence in EU countries.

  References

  1. Gimeno D, Benavides FG, Benach J, Amick BCIII. Distribution of sickness absence in the European Union countries. Occup Environ Med 2004;61:867-9.

  2. Kauppinen T, Hanhela R, Heikkilä P et al. Work and Health in Finland 2003. Finnish Institute of Occupational Health, Helsinki, 2004.

  3. Stansfeld SA, Head J, Rasul F, Singleton N, Lee A. Occupation and mental health: Secondary analyses of the ONS Psychiatric Morbidity Survey of Great Britain. Research Report 168, Health and Safety Executive Books, 2003.

  4. Vahtera J, Pentti J, Kivimäki M. Sickness absence as a predictor of mortality among male and female employees. J Epidemiol Community Health 2004;58:321-6.

  5. Kivimäki M, Virtanen M, Vartia M, Elovainio M, Vahtera J, Keltikangas-Järvinen L. Workplace bullying and the risk of cardiovascular disease and depression. Occup Environ Med 2003;60:779-83.

  6. Kivimäki M, Head J, Ferrie JE, Shipley MJ, Vahtera J, Marmot MG. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ 2003;327:364-8.

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  Conflict of Interest:
  None declared.

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