Intended for healthcare professionals


Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark

BMJ 2006; 332 doi: (Published 23 February 2006) Cite this as: BMJ 2006;332:449
  1. Thomas Lund, researcher (tl{at},
  2. Merete Labriola, researcher1,
  3. Karl Bang Christensen, statistician1,
  4. Ute Bültmann, researcher1,
  5. Ebbe Villadsen, data manager1
  1. 1 National Institute of Occupational Health, Lerso Parkallé 105, DK-2100 Copenhagen, Denmark
  1. Correspondence to: T Lund
  • Accepted 24 December 2005


Objectives To examine the effects of physical work environment on long term sickness absence and to investigate interaction between physical and psychosocial risk factors.

Design and setting Prospective cohort study of long term sickness absence among employees in Denmark.

Participants 5357 employees interviewed in 2000 about their physical work environment, and various covariates were followed for 18 months in a national sickness absence register.

Outcome measurements Cox regression analysis was performed to assess risk estimates for physical risk factors in the work environment and onset of long term sickness absence, defined as receiving sickness absence compensation for eight consecutive weeks or more.

Results 348 participants (6.9%) developed long term sickness absence during follow-up. Of these, 194 (55.7%) were women and 154 (44.3%) were men. For both female and male employees, risk of onset of long term sickness absence was increased by extreme bending or twisting of the neck or back, working mainly standing or squatting, lifting or carrying loads, and pushing or pulling loads. Significant interactions were found for three combinations of physical and psychosocial work environment risk factors among female employees (P<0.05).

Conclusion Uncomfortable working positions, lifting or carrying loads, and pushing or pulling loads increased the risk of onset of long term sickness absence. The study shows a potential for reducing long term sickness absence through modifying work postures straining the neck and back, reducing the risk of work done standing or walking, and reducing the risk associated with handling loads. Dealing with psychosocial stressors simultaneously may improve physical intervention efforts further for female employees.


  • Contributors TL, ML, KBC, and UB contributed to the initiation of the study, study design, conduct of the study, statistical analysis, and preparation of the manuscript. EV contributed to conduct of the study, data management and preparation of the manuscript. TL is guarantor.

  • Funding None.

  • Competing interests None declared.

  • Ethical approval The study has been notified to and registered by Datatil-synet (the Danish Data Protection Agency). According to Danish law, questionnaire and register based studies do not need approval by ethical and scientific committees, nor informed consent.

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