BMJ  2003;327:364 (16 August), doi:10.1136/bmj.327.7411.364

Paper

Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study

¹ Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland, ² International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT

Objective To examine the association between sickness absence and mortality compared with associations between established health indicators and mortality.

Design Prospective cohort study. Medical examination and questionnaire survey conducted in 1985-8; sickness absence records covered the period 1985-98.

Setting 20 civil service departments in London.

Participants 6895 male and 3413 female civil servants aged 35-55 years.

Main outcome measure All cause mortality until the end of 1999.

Results 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.

Conclusion 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.

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