Reuter Marvin, Dragano Nico, Wahrendorf Morten
Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany
Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Dusseldorf, Germany.
J Epidemiol Community Health. 2020 Nov 13. doi: 10.1136/jech-2020-214888.
Research suggests that areas with high unemployment have lower rates of sickness absence, but the underlying mechanisms remain unclear. One assumption is that when unemployment is high people are more likely to work while being sick (discipline hypothesis). Against this background, we investigate the association between regional unemployment and sickness presenteeism. Second, we study interactions with factors of occupational disadvantage.
We combined survey data of 20 974 employees collected 2015 in 232 regions from 35 European countries with data on regional unemployment rates obtained from Eurostat. Presenteeism was assessed by the fraction of days worked while ill among all days with illness (presenteeism propensity). To investigate if unemployment was related to presenteeism, we estimated multi-level models (individuals nested in regions) that were adjusted for socio-demographic and occupational covariates to account for compositional differences of the regions.
The mean presenteeism propensity was 34.8 (SD 40.4), indicating that workers chose presenteeism in 1 out of 3 days with sickness. We found that a change in unemployment by +10 percentage points was associated with a change in presenteeism by +5 percentage points (95% CI 1.2 to 8.6). This relationship was more pronounced among workers with low salary, low skill-level, and industrial and healthcare workers.
Our results support the assumption that high unemployment elevates presenteeism, and that people in disadvantaged occupations are particularly affected. Policies managing presenteeism should consider the labour market context, particularly during the aftermath of the COVID-19 pandemic.
研究表明，高失业率地区的病假缺勤率较低，但其潜在机制仍不清楚。一种假设是，当失业率较高时，人们在生病时更有可能继续工作（纪律假设）。在此背景下，我们研究了地区失业率与带病上班之间的关联。其次，我们研究了与职业劣势因素的相互作用。
我们将2015年在35个欧洲国家的232个地区收集的20974名员工的调查数据与从欧盟统计局获得的地区失业率数据相结合。带病上班情况通过在所有患病天数中带病工作的天数比例（带病上班倾向）来评估。为了研究失业率是否与带病上班有关，我们估计了多层次模型（个体嵌套在地区中），并对社会人口统计学和职业协变量进行了调整，以考虑地区的构成差异。
平均带病上班倾向为34.8（标准差40.4），这表明员工在每3个患病日中就有1天选择带病上班。我们发现，失业率每增加10个百分点，带病上班率就会增加5个百分点（95%置信区间1.2至8.6）。这种关系在低薪、低技能水平的工人以及工业和医疗保健行业的工人中更为明显。
我们的结果支持了高失业率会提高带病上班率这一假设，并且处于劣势职业的人群受到的影响尤为明显。管理带病上班问题的政策应考虑劳动力市场背景，尤其是在新冠疫情之后。
