Intended for healthcare professionals


Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study

BMJ 2008; 337 doi: (Published 02 October 2008) Cite this as: BMJ 2008;337:a1469
  1. Jenny Head, reader in medical and social statistics1,
  2. Jane E Ferrie, senior research fellow1,
  3. Kristina Alexanderson, professor2,
  4. Hugo Westerlund, senior researcher3,
  5. Jussi Vahtera, research professor4,
  6. Mika Kivimäki, professor14
  1. 1Department of Epidemiology and Public Health, University College London, London
  2. 2Department of Clinical Neuroscience, Section of Personal Injury Prevention, Karolinska Institutet, Berzelius väg 3, 171 77 Stockholm, Sweden
  3. 3Stress Research Institute, Stockholm University, SE-106 91, Stockholm
  4. 4Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland
  1. Correspondence to: J Head j.head{at}
  • Accepted 15 July 2008


Objective To investigate whether knowing the diagnosis for sickness absence improves prediction of mortality.

Design Prospective cohort study established in 1985-8. Sickness absence records including diagnoses were obtained from computerised registers.

Setting 20 civil service departments in London.

Participants 6478 civil servants aged 35-55 years.

Main outcome measures All cause, cardiovascular, and cancer mortality until 2004, average follow-up 13 years.

Results After adjustment for age, sex, and employment grade, employees who had one or more medically certified spells of sickness absence (>7 days) in a three year period had a mortality 1.7 (95% CI 1.3 to 2.1) times greater than those with no medically certified spells. Inclusion of diagnoses improved the prediction of all cause mortality (P=0.03). The hazard ratio for mortality was 4.7 (2.6 to 8.5) for absences with circulatory disease diagnoses, 2.2 (1.4 to 3.3) for surgical operations, and 1.9 (1.2 to 3.1) for psychiatric diagnoses. Psychiatric absences were also predictive of cancer mortality (2.5 (1.3 to 4.7)). Associations of infectious, respiratory, and injury absences with overall mortality were less marked (hazard ratios from 1.5 to 1.7), and there was no association between musculoskeletal absences and mortality.

Conclusions Major diagnoses for medically certified absences were associated with increased mortality, with the exception of musculoskeletal disease. Data on sickness absence diagnoses may provide useful information to identify groups with increased health risk and a need for targeted interventions.


  • We thank all participating civil service departments and their welfare, personnel, and establishment officers; the Occupational Health and Safety Agency; the Council of Civil Service Unions; all participating civil servants in the Whitehall II study; all members of the Whitehall II study team.

  • Contributors: All authors jointly designed the hypothesis, analysed and interpreted the data, and wrote the paper. JH is guarantor for the paper.

  • Funding: The Whitehall II study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH: National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. JEF is supported by the MRC (grant No G8802774), KA is supported by the Swedish Council for Working life and Social Research, HW is supported by a programme grant from the Swedish Council for Working Life and Social Research (FAS grant No 2004-2021), and MK and JV are supported by the Academy of Finland (Projects No 117614, 124322, and 124271).

  • Competing interests: None declared.

  • Ethical approval: Ethical approval for the Whitehall II study was obtained from the University College London Medical School committee on the ethics of human research.

  • Accepted 15 July 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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