Research Article

Explaining socioeconomic differences in sickness absence: the Whitehall II Study.

BMJ 1993; 306 doi: (Published 06 February 1993) Cite this as: BMJ 1993;306:361
  1. F North,
  2. S L Syme,
  3. A Feeney,
  4. J Head,
  5. M J Shipley,
  6. M G Marmot
  1. Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.


    OBJECTIVE--To describe and explain the socioeconomic gradient in sickness absence. DESIGN--Analysis of questionnaire and sickness absence data collected from the first phase of the Whitehall II study. Grade of employment was used as a measure of socioeconomic status. SETTING--20 civil service departments in London. SUBJECTS--6900 male and 3414 female civil servants aged 35-55 years. MAIN OUTCOME MEASURES--Rates of short spells (< or = 7 days) and long spells (> 7 days) of sickness absence. RESULTS--A strong inverse relation between grade of employment and sickness absence was evident. Men in the lowest grade had rates of short and long spells of absence 6.1 (95% confidence interval 5.3 to 6.9) and 6.1 (4.8 to 7.9) times higher than those in the highest grade. For women the corresponding rate ratios were 3.0 (2.3 to 3.9) and 4.2 (2.5 to 6.8) respectively. Several risk factors were identified, including health related behaviours (smoking and frequent alcohol consumption), work characteristics (low levels of control, variety and use of skills, work pace, and support at work), low levels of job satisfaction, and adverse social circumstances outside work (financial difficulties and negative support). These risk factors accounted for about one third of the grade differences in sickness absence. CONCLUSION--Large grade differences in sickness absence parallel socioeconomic differences in morbidity and mortality found in other studies. Identified risk factors accounted for a small proportion of the grade differences in sickness absence. More accurate measurement of the risk factors may explain some of the remaining differences in sickness absence but other factors, as yet unrecognised, are likely to be important.