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Abstract
Objectives Psychosocial working conditions are predictors of musculoskeletal and psychiatric sickness absence. Our objective was to examine whether these factors mediate socioeconomic inequalities in sickness absence in a life-course perspective, including indicators of both childhood and adult socioeconomic position (SEP).
Methods Our study sample was all employed individuals who partook in the HUNT study and who were born between 1967 and 1976 (N = 4530). Outcome was the risk of at least one sickness absence episode in 2009, with musculoskeletal and psychiatric diagnoses, respectively. Educational attainment (4 categories) served as indicator of adult SEP, whereas highest parental education level and father’s average income during early childhood (0–6 years) were indicators of childhood SEP. Work factors were job control, job strain, social support and bullying. Risk ratios (RRs) were estimated using Poisson regression.
Results 10% among both women and men had musculoskeletal sickness absence during follow-up, whereas 7% of the women and 3% of the men had psychiatric sickness absence. There were strong social gradients according to adult SEP for both genders and both diagnoses, but strongest for musculoskeletal disorders. RRs for having a musculoskeletal sickness absence episode, comparing highest and lowest educational levels, were 5.4 for women and 7.2 for men, adjusted for age and childhood SEP, and 3.0 and 4.6, respectively, for psychiatric diagnoses. Including all work factors reduced the RRs, most for psychiatric sickness absence among men (20%), with largest impact for job strain (13%), job control (10%) and bullying (9%) in separate analyses. The largest RR reduction for musculoskeletal sickness absence was among women (10%), with largest impact for job control (10%) and job strain (8%).
Conclusions There were strong social gradients in sickness absence, which were somewhat attenuated when adjusting for psychosocial work factors, indicating that these factors may partly mediate the social gradients in a life-course perspective.