Occupational class differences in sickness absence: changes over time and diagnostic causes

Forskningsoutput: AvhandlingDoktorsavhandlingSamling av artiklar


Sickness absence indicates ill-health among working populations and gives rise to notable costs due to lost working days. Employees in lower occupational classes have more sickness absence compared to those in higher classes. Extending working careers by reducing sickness absence has been a target at the national level in many Western countries due to ageing workforce and weakening economic dependency ratio. Socioeconomic differences in health, in turn, have remained significant over time. However, less is known about changes in occupational class differences in sickness absence over time in nationwide populations. The aim of this study was to examine occupational class differences in long-term sickness absence and underlying diagnostic causes of the class differences over time in the Finnish employed population. The study was based on data obtained from national registers. A 70% random sample of working-age Finnish residents was linked to data on medically certified sickness absence of over 10 working days based on paid sickness allowances retrieved from the Social Insurance Institution of Finland. Data on occupational class was obtained from Statistics Finland. The study focused on upper non-manual employees, lower non-manual employees and manual workers. The study covered the years from 1996 to 2014, the diagnosis-specific examination spanning from 2005 to 2014. Statistical methods included a direct age-standardisation method, the Slope Index of Inequality (SII), the Relative Index of Inequality (RII) and a negative binomial hurdle model. The results showed that, despite modest annual variations, occupational class differences in all-cause sickness absence were clear and persistent among both genders over time. Lower occupational class was consistently associated with higher all-cause sickness absence, both in absolute and relative terms, with men having larger differences than women. The most prominent class differences were detected in sickness absence due to musculoskeletal diseases throughout, with men having very large relative differences. With regard to specific musculoskeletal diagnoses, the class differences in the occurrence of absence were by far the largest in shoulder disorders and back pain. Chronic musculoskeletal diseases, namely rheumatoid arthritis, disc disorders and, among men, also hip osteoarthritis, caused the largest class differences in the length of absence. During the study period, large occupational class differences were also detected in sickness absence due to home and leisure injuries, particularly among men. In contrast, modest occupational class differences were found in sickness absence due to mental disorders among both genders. Among women, a divergent pattern was found in sickness absence due to breast cancer: the higher the class, the greater the cumulative incidence but the shorter the duration of absence throughout. Health inequalities have remained prominent over time in the Finnish working population. No major progress has taken place, despite several health policy programs aiming at reducing socioeconomic health differences over time. Future actions should have a specific emphasis on employees in lower occupational classes and on manual workers in particular in order to tackle the class differences in sickness absence effectively. The study further highlights that sickness absence due to musculoskeletal diseases, especially prevention of sickness absence due to back pain and shoulder disorders, and home and leisure injuries should be paid attention in the future.
  • Rahkonen, Ossi, Handledare
  • Blomgren, Jenni, Handledare, Extern person
  • Lahelma, Eero, Handledare
Tilldelningsdatum27 jul 2018
Tryckta ISBN978-951-51-4339-6
Elektroniska ISBN978-951-51-4340-2
StatusPublicerad - 2018
MoE-publikationstypG5 Doktorsavhandling (artikel)

Bibliografisk information

M1 - 79 s. + liitteet


  • 3142 Folkhälsovetenskap, miljö och arbetshälsa

Citera det här