Article Text

The association between shift work and sick leave: a systematic review
  1. Suzanne L Merkus1,2,
  2. Alwin van Drongelen2,3,
  3. Kari Anne Holte1,
  4. Merete Labriola4,5,
  5. Thomas Lund4,5,
  6. Willem van Mechelen2,
  7. Allard J van der Beek2
  1. 1Research Group Working life and Innovation, International Research Institute of Stavanger, Stavanger, Norway
  2. 2Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
  3. 3KLM Health Services, Schiphol Airport, Amsterdam, The Netherlands
  4. 4Danish Ramazzini Centre at the Department of Occupational Medicine, Regional Hospital Herning, Herning, Denmark
  5. 5National Centre for Occupational Rehabilitation, Rauland, Norway
  1. Correspondence to Suzanne L Merkus, P.O. Box 8046, 4068 Stavanger, Norway; suzanne.merkus{at}


Shift work is associated with a number of negative health outcomes, although it is not known whether it is associated with sick leave. This systematic review therefore aimed to determine whether an association exists between shift work and sick leave. A systematic literature search was conducted in six databases on observational studies. Two reviewers independently selected relevant articles and appraised methodological quality. Data extraction was performed independently by review couples. Articles were categorised according to shift work characteristics and summarised using a levels of evidence synthesis. In total, the search strategy yielded 1207 references, of which 24 studies met the inclusion criteria. Nine studies were appraised as high quality and used in the levels of evidence synthesis. Two high quality longitudinal studies found a positive association between fixed evening shifts and longer sick leave for female healthcare workers. The evidence was assessed as strong. Evidence was inconclusive for rotating shifts, shift work including nights, for fixed night work, and for 8-hour and 12-hour shifts. The association found between evening work and sick leave in female healthcare workers implies that the association between shift work and sick leave might be schedule and population specific. To study the association further, more high quality studies are necessary that assess and adjust for detailed shift work exposure.

  • Work schedule tolerance
  • shift work
  • sick leave
  • systematic review
  • epidemiology
  • materials
  • exposures and occupational groups
  • fatigue
  • methodology
  • speciality
  • sickness absence
  • ergonomics
  • health promotion
  • musculoskeletal
  • exposure assessment

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:


  • Funding This review received funding from the Research Council of Norway.

  • Competing interests None.

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