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Sickness absence as a prognostic marker for common chronic conditions: analysis of mortality in the GAZEL study
  1. M Kivimäki1,
  2. J Head1,
  3. J E Ferrie1,
  4. A Singh-Manoux2,
  5. H Westerlund3,
  6. J Vahtera4,
  7. A Leclerc2,
  8. M Melchior2,
  9. A Chevalier5,
  10. K Alexanderson6,
  11. M Zins2,
  12. M Goldberg2
  1. 1
    Department of Epidemiology and Public Health, University College London, London, UK
  2. 2
    INSERM, U687-IFR69, Hopital Paul Brousse, Villejuif, France
  3. 3
    Stress Research Institute, Stockholm University, Stockholm, Sweden
  4. 4
    Finnish Institute of Occupational Health, Helsinki, Finland
  5. 5
    French Institute for Public Health Surveillance, Department of Occupational Health, Saint-Maurice, France
  6. 6
    Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
  1. M Kivimaki, Department of Epidemiology and Public Health, University College London, 1–19 Torrington Place, London WC1E 6BT, UK; m.kivimaki{at}


Objectives: To determine whether sickness absence is a prognostic marker in terms of mortality among people with common chronic conditions.

Methods: Prospective occupational cohort study of 13 077 men and 4871 women aged 37–51 from the National Gas and Electricity Company, France. Records of physician-certified sickness absences over a 3-year period were obtained from employers’ registers. Chronic conditions were assessed in annual surveys over the same period. The main outcome measure was all-cause mortality (803 deaths, mean follow-up after assessment of sickness absence: 13.9 years).

Results: In Cox proportional hazard models adjusted for age, sex, socioeconomic position and co-morbidity, >28 annual sickness-absence days versus no absence days was associated with an excess mortality risk among those with cancer (hazard ratio 5.4, 95% CI 2.2 to 13.1), depression (1.7, 1.1 to 2.8), chronic bronchitis or asthma (2.7, 1.6 to 4.6) and hypertension (1.6, 1.0 to 2.6). The corresponding hazard ratios for more than five long (>14 days) sickness-absence episodes per 10 person-years versus no such episodes were 5.4 (2.2 to 13.1), 1.8 (1.3 to 2.7), 2.0 (1.3 to 3.2) and 1.8 (1.2 to 2.7), respectively. Areas under receiver operating characteristics curves for these absence measures varied between 0.56 and 0.73, indicating the potential of these measures to distinguish groups at high risk of mortality. The findings were consistent across sex, age and socioeconomic groups and in those with and without co-morbid conditions.

Conclusion: Data on sickness absence may provide useful prognostic information for common chronic conditions at the population level.

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  • Funding: MK and JV are supported by the Academy of Finland (projects 117604, 124322 and 124271) and the Finnish Environment Fund, and HW and KA by the Swedish Council for Working Life and Social Research. JEF is supported by the MRC (grant number 8802774) and AS-M by a EUYRI award from the European Science Foundation. The GAZEL cohort was funded by EDF-GDF and INSERM, and received grants from the Association de la Recherche sur le Cancer and from the Fondation de France.

  • Competing interests: None.

  • Contributors: All authors formulated the hypothesis, analysed/interpreted the data and wrote the paper. MK is guarantor for the paper. MZ and MG are the Principal Investigators of the GAZEL study.