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Differences in the association between sickness absence and long-term sub-optimal health by occupational position: a 14-year follow-up in the GAZEL cohort
  1. Jane E Ferrie1,
  2. Mika Kivimäki1,2,
  3. Hugo Westerlund3,
  4. Jenny Head1,
  5. Maria Melchior4,
  6. Archana Singh-Manoux1,4,
  7. Marie Zins4,
  8. Marcel Goldberg4,
  9. Kristina Alexanderson5,
  10. Jussi Vahtera2,6
  1. 1Department of Epidemiology and Public Health, UCL, London, UK
  2. 2Finnish Institute of Occupational Health, Helsinki, Finland
  3. 3Stress Research Institute, Stockholm University, Stockholm, Sweden
  4. 4INSERM U1018, CESP Occupational and Social Determinants of Health, Villejuif, France
  5. 5Division of Insurance Medicine, Karolinska Institute, Stockholm, Sweden
  6. 6Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  1. Correspondence to Jane Ferrie, Department of Epidemiology and Public Health, UCL, 1–19 Torrington Place, London WC1E 6BT, UK; j.ferrie{at}


Objectives Although sickness absence is a strong predictor of health, whether this association varies by occupational position has rarely been examined. The aim of this study was to investigate overall and diagnosis-specific sickness absence as a predictor of future long-term sub-optimal health by occupational position.

Methods This was a prospective occupational cohort study of 15 320 employees (73% men) aged 37–51. Sickness absences (1990–1992), included in 13 diagnostic categories, were examined by occupational position in relation to self-rated health measured annually during 1993–2006.

Results 60% of employees in higher occupational positions and 22% in lower positions had no sickness absence. Conversely, 9.5% of employees in higher positions and 40% in lower positions had over 30 sick-leave days. Repeated-measures logistic regression analyses adjusted for age, sex and chronic disease showed employees with over 30 days absence, compared to those with no absence, had approximately double the risk of sub-optimal health over the 14-year follow-up in all occupational positions. 1–30 days sick-leave was associated with greater odds of sub-optimal health in the high (OR 1.48; 95% CI 1.27 to 1.72) and intermediate (1.29; 1.15 to 1.45) but not lower occupational positions (1.06; 0.82 to 1.38). Differences by occupational position in the association between sickness absence in 13 specific diagnostic categories and sub-optimal health over the ensuing 14 years were limited to stronger associations observed with cancer and mental disorders in the higher occupational positions.

Conclusions The association between sickness absence of more than 30 days over 3 years and future long-term self-rated health appears to differ little by occupational position.

  • Sickness absence
  • sick leave
  • self-rated health
  • longitudinal
  • multi-level
  • occupational position
  • epidemiology
  • fitness for work
  • longitudinal studies
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  • Funding This work was supported by an ESRC Research Seminar Series Competition 2007/8 (RES-451-26-0491). JV and MK are supported by the Academy of Finland (grants #124271, #124322 and #129262), HW is supported by the Swedish Council for Working Life and Social Research (FAS; grants #2004-2021 and #2007-1143). ASM, JEF and JH are supported by the National Institutes on Ageing (NIA RO1AG013196). AS-M is supported by a EUYRI award from the European Science Foundation. KA was supported by the Swedish Council for Working Life and Social Research. The GAZEL Cohort Study 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.

  • Ethics approval The GAZEL study received the approval of France's national ethics committee (Commission Nationale Informatique et Liberté, CNIL).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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