Torá-Rocamora Isabel, Martínez José Miguel, Gimeno David, Alberti Constança, Jardí Josefina, Manzanera Rafael, Benavides Fernando G, Delclos George
Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Red de investigacion en servicios de salud en enfermedades cronicas (REDISSEC), Spain; Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain.
Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain.
Gac Sanit. 2015 May-Jun;29(3):164-71. doi: 10.1016/j.gaceta.2014.12.004. Epub 2015 Jan 28.
To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors.
All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated.
We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32).
County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.
研究非工作相关病假（NWRSA）时长在不同地理区域的差异，以及这种差异在多大程度上可由个体因素和/或环境因素来解释。
对所有于2007年和2010年结束的首次NWRSA发作进行分析。分析个体因素（诊断、年龄、性别）和环境因素（医疗资源、社会经济因素），以评估这些因素能在多大程度上解释地理差异。加泰罗尼亚各郡县绘制了四分位数中的NWRSA时长中位数。拟合了发作嵌套于郡县内的多水平Cox比例风险回归模型，以量化这种差异的大小。计算了方差的比例变化（PCV）、中位数风险比（MHR）和四分位间距风险比（IHR）。
我们发现NWRSA时长存在地理模式，加泰罗尼亚西北部的时长更长。NWRSA时长存在虽小但具有统计学意义的地理差异，在对个体因素进行调整后，这种差异在女性（2007年：PCV = 34.98%，MHR = 1.09，IHR = 1.13；2010年：PCV = 34.68%，MHR = 1.11，IHR = 1.28）和男性（2007年：PCV = 39.88%，MHR = 1.10，IHR = 1.27；2010年：PCV = 45.93%，MHR = 1.10，IHR = 1.25）中大多有所减小；仅在2010年女性的情况中，由于环境协变量，县级方差有所降低（PCV = 16.18%，MHR = 1.12，IHR = 1.32）。
NWRSA时长的县级差异较小，更多地由个体变量而非环境变量所解释。需要了解NWRSA时长的地理差异，以规划特定项目和干预措施，尽量减少这些差异。
