Westerlund Hugo, Ferrie Jane, Hagberg Jan, Jeding Kerstin, Oxenstierna Gabriel, Theorell Töres
National Institute for Psychosocial Medicine, Stockholm, Sweden.
Lancet. 2004 Apr 10;363(9416):1193-7. doi: 10.1016/S0140-6736(04)15949-7.
Downsizing has in previous studies, as well as in public debate, been associated with increased sickness absence. No studies have, however, looked at the long-term relation between workplace expansion and morbidity.
We investigated exposure to personnel change during 1991-96 in relation to long-term (90 days or longer) medically certified sickness absence and hospital admission for specified diagnoses during 1997-99 in 24?036 participants with a complete employment record in the biennial national Swedish Work Environment Surveys from 1989 to the end of 1999.
Accumulated exposure to large expansion (> or =18% per year) was related to an increased risk of long-term sickness absence (odds ratio 1.07 [95% CI 1.01-1.13], p=0.013) and hospital admission (1.09 [1.02-1.16], p=0.017). In this context, odds ratio signifies the change in odds for each additional year of exposure, varying from 0 to 6. Moderate expansion (> or =8% and <18% per year), was associated with a decreased risk of admission (0.91 [0.84-0.98], p=0.012). Moderate downsizing (> or =8% and <18% per year) was associated with an increased risk of sickness absence (1.07 [1.02-1.12], p=0.003). The strongest association between large expansion and sickness absence was in women in the public sector (1.18 [1.08-1.30], p=0.0002), corresponding to an odds ratio of 2.77 [1.62-4.74] between full exposure (all 6 years) and no exposure.
This study confirms earlier findings that downsizing is associated with health risks. It also shows that repeated exposure to rapid personnel expansion, possibly connected with centralisation of functions, statistically predicts long-term sickness absence and hospital admission. Although no conclusions about causal pathways can be drawn from our results, this exposure should be considered in future studies, policy making, and occupational health care practice.
在以往研究以及公众辩论中，裁员一直与病假增加有关。然而，尚无研究探讨工作场所扩张与发病率之间的长期关系。
我们调查了1991 - 1996年期间人员变动情况与1997 - 1999年期间长期（90天及以上）经医学证明的病假以及特定诊断的住院情况之间的关系，研究对象为24036名参与者，他们在1989年至1999年底的瑞典全国性两年一次工作环境调查中有完整的就业记录。
长期经历大规模扩张（每年增长≥18%）与长期病假风险增加（比值比1.07 [95%置信区间1.01 - 1.13]，p = 0.013）以及住院风险增加（1.09 [1.02 - 1.16]，p = 0.017）相关。在此背景下，比值比表示每增加一年暴露的比值变化，范围从0到6。适度扩张（每年增长≥8%且<18%）与住院风险降低相关（0.91 [0.84 - 0.98]，p = 0.012）。适度裁员（每年减少≥8%且<18%）与病假风险增加相关（1.07 [1.02 - 1.12]，p = 0.003）。大规模扩张与病假之间最强的关联出现在公共部门的女性中（1.18 [1.08 - 1.30]，p = 0.0002），完全暴露（全部6年）与无暴露之间的比值比为2.77 [1.62 - 4.74]。
本研究证实了早期的研究结果，即裁员与健康风险相关。研究还表明，反复经历快速的人员扩张，可能与职能集中有关，在统计学上可预测长期病假和住院情况。尽管我们的结果无法得出关于因果途径的结论，但在未来的研究、政策制定和职业卫生保健实践中应考虑这种暴露情况。
