Kivimäki Mika, Head Jenny, Ferrie Jane E, Shipley Martin J, Vahtera Jussi, Marmot Michael G
Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland.
BMJ. 2003 Aug 16;327(7411):364. doi: 10.1136/bmj.327.7411.364.
To examine the association between sickness absence and mortality compared with associations between established health indicators and mortality.
Prospective cohort study. Medical examination and questionnaire survey conducted in 1985-8; sickness absence records covered the period 1985-98.
20 civil service departments in London.
6895 male and 3413 female civil servants aged 35-55 years.
All cause mortality until the end of 1999.
After adjustment for age and grade, men and women who had more than five medically certified absences (spells > 7 days) per 10 years had a mortality 4.8 (95% confidence interval 3.3 to 6.9) and 2.7 (1.5 to 4.9) times greater than those with no such absence. Poor self rated health, presence of longstanding illness, and a measure of common clinical conditions comprising diabetes, diagnosed heart disease, abnormalities on electrocardiogram, hypertension, and respiratory illness were all associated with mortality--relative rates between 1.3 and 1.9. In a multivariate model including all the above health indicators and additional health risk factors, medically certified sickness absence remained a significant predictor of mortality. No linear association existed between self certified absence (spells 1-7 days) and mortality, but the findings suggest that a small amount of self certified absence is protective.
Evidence linking sickness absence to mortality indicates that routinely collected sickness absence data could be used as a global measure of health differentials between employees. However, such approaches should focus on medically certified (or long term) absences rather than self certified absences.
研究病假与死亡率之间的关联，并与既定健康指标和死亡率之间的关联进行比较。
前瞻性队列研究。于1985 - 1988年进行医学检查和问卷调查；病假记录涵盖1985 - 1998年期间。
伦敦的20个公务员部门。
6895名年龄在35 - 55岁之间的男性公务员和3413名女性公务员。
截至1999年底的全因死亡率。
在对年龄和职级进行调整后，每10年有超过5次医学证明病假（持续时间>7天）的男性和女性，其死亡率分别比无此类病假者高4.8倍（95%置信区间3.3至6.9）和2.7倍（1.5至4.9）。自我评估健康状况差、患有长期疾病以及一项包含糖尿病、确诊心脏病、心电图异常、高血压和呼吸系统疾病的常见临床状况指标均与死亡率相关——相对比率在1.3至1.9之间。在包含上述所有健康指标及其他健康风险因素的多变量模型中，医学证明的病假仍然是死亡率的显著预测因素。自我证明病假（持续时间1 - 7天）与死亡率之间不存在线性关联，但研究结果表明少量的自我证明病假具有保护作用。
将病假与死亡率联系起来的证据表明，常规收集的病假数据可作为衡量员工健康差异的一项综合指标。然而，此类方法应侧重于医学证明（或长期）病假，而非自我证明病假。
