De Rijk Angelique, Janssen Nathalie, Alexanderson Kristina, Nijhuis Frans
Department of Social Medicine, Maastricht University, Maastricht, The Netherlands.
Int J Rehabil Res. 2008 Dec;31(4):327-36. doi: 10.1097/MRR.0b013e3282fba37c.
This article describes (i) gender differences in initial return to work (RTW) and lasting return to work (LRTW); (ii) health characteristics that predicted the observed gender differences in LRTW; and (iii) associations between health characteristics and (L)RTW in men and women separately. A 13-month prospective cohort study was performed with 119 employees (54 women and 65 men) who had reported sick for more than 1 month because of mental or musculoskeletal complaints. These employees were interviewed bimonthly about their work status and health. The health characteristics included were self-rated health, the reason for reporting sick, the presence of at least one long-term disease, early improvement in health and a change in diagnosis. Cox regression analyses on the time to (L)RTW were performed. No gender differences were found regarding RTW. Women, however, did report a longer time to LRTW than men. This was predicted by their reason for reporting sick, the presence of at least one long-term disease, lack of early improvement in health and change in diagnosis. Women who experienced no early improvement and/or whose diagnosis changed during their sickness absence had lower chances of attaining a LRTW than other women. Men who were absent owing to mental complaints were less likely to RTW than men with musculoskeletal complaints. Men who had at least one long-term disease were also less likely to RTW than men who had no long-term diseases. The findings showed a delayed LRTW for women when compared with men, as predicted by health characteristics. The health characteristics, however, that predicted LRTW in women differed from those that predicted LRTW in men. Clearly, the findings support a gender-specific approach to sickness absence guidance. The results also suggest that women are misdiagnosed more often than men. This requires further investigation.
（i）首次复工（RTW）和持续复工（LRTW）中的性别差异；（ii）预测LRTW中观察到的性别差异的健康特征；以及（iii）健康特征与男性和女性的（L）RTW之间的关联。对119名因精神或肌肉骨骼疾病病假超过1个月的员工（54名女性和65名男性）进行了为期13个月的前瞻性队列研究。每两个月对这些员工进行一次关于其工作状态和健康状况的访谈。纳入的健康特征包括自我评估的健康状况、病假原因、至少一种慢性病的存在、健康状况的早期改善以及诊断的变化。对（L）RTW时间进行了Cox回归分析。在RTW方面未发现性别差异。然而，女性报告的LRTW时间比男性长。这可由她们的病假原因、至少一种慢性病的存在、健康状况缺乏早期改善以及诊断变化来预测。在病假期间没有早期改善和/或诊断发生变化的女性实现LRTW的机会低于其他女性。因精神疾病请假的男性比因肌肉骨骼疾病请假的男性复工可能性更小。患有至少一种慢性病的男性比没有慢性病的男性复工可能性也更小。研究结果表明，与男性相比，女性的LRTW延迟，这可由健康特征预测。然而，预测女性LRTW的健康特征与预测男性LRTW的健康特征不同。显然，研究结果支持针对病假指导采取针对性别的方法。结果还表明，女性比男性更容易被误诊。这需要进一步调查。
