[Show abstract][Hide abstract] ABSTRACT: Objective: Prevalence of chronic conditions is increasing. Previous research on multimorbidity (MMB) has mainly focused on patient and older populations, but studies in the workforce are scarce. MMB affects both quality of life and work ability. We estimated the effect of MMB on the incidence of sickness absence (SA).
Methods: Retrospective cohort study (2004-2008) of 372,370 workers. In 2006, a uniform questionnaire collected information on chronic conditions, health-related symptoms and behaviors, used to construct a sex-specific MMB score (MMBS) that ranged from 0 to 100.We categorized individuals with scores >0 into low, moderate and high MMB tertiles, in addition to a group with MMBS = 0.We fit a Cox model, adjusted for age, occupational social class and number of prior SA episodes, to estimate the effect of MMBS on incident SA episodes due to cardiovascular diseases (CVD), musculoskeletal (MS) and mental disorders (MD).Specific pathologies were also analyzed [ischemic diseases (ICD9 410-414); dorsopathies (ICD9: 742.2,724.3) and nonpsychotic MD (ICD9 296.2,296.3,300.xx,301.1,309.x,311)].All analyses were performed for both sexes.
Results: For SA due to CVD and MS men showed a trend of higher SA incidence risk from low [HR = 1.13(95%CI:0.80-1.59) for CVD; HR = 1.23(95%CI:1.07-1.42) for MS] to high MMBS [HR = 1.66(95%CI:1.26-2.19) for CVD; HR = 1.31(95%CI:1.15-1.47) for MS]. Ischemic episodes showed the same pattern [from HR = 2.23(95%CI:0.75-6.65) to [HR = 5.84(95%CI:2.34-14.54)]. Women had increased MD episodes for low MMBS [HR = 1.66(95%CI:1.27-2.17), whereas men for moderate and high MMBS [HR = 1.55(95%CI:1.15-2.07); HR = 1.43(95%CI:1.11-1.85)]. High MMBS was associated with greater incidence of dorsopathies [HR = 1.21(95%CI:1.01-1.47)] and nonpsychotic MD [HR = 1.46(95%CI:1.01-1.94)].
Conclusions: MMB increases the risk of incident SA episodes due to CVD, MS, MD and specific pathologies in both sexes. Future studies should focus on the impact of MMB on relevant occupational outcomes.
Key messages: Multimorbidity increases incident sickness absence affecting work ability and worker's productivity. Research should continue targeting the impact of multimorbidity on occupational outcomes.
European Public Health Conference, European Journal of Publich Health; 10/2014
[Show abstract][Hide abstract] ABSTRACT: We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons.
The European Journal of Public Health 06/2014; · 2.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While sociodemographic and work-related factors are frequently studied as determinants of sickness absence (SA), health-related determinants have surprisingly received little attention. We examined the effect of multimorbidity and previous SA on the incidence and duration of future SA.
[Show abstract][Hide abstract] ABSTRACT: Most frequently, multimorbidity measures available in the literature are heavily dependent on one outcome. We propose a method to construct a global multimorbidity score that incorporates chronic and non-chronic health conditions as well as health-related behaviours and symptoms, regardless of any specific outcome.
[Show abstract][Hide abstract] ABSTRACT: To investigate the effect of fast food consumption on mean population body mass index (BMI) and explore the possible influence of market deregulation on fast food consumption and BMI.
The within-country association between fast food consumption and BMI in 25 high-income member countries of the Organisation for Economic Co-operation and Development between 1999 and 2008 was explored through multivariate panel regression models, after adjustment for per capita gross domestic product, urbanization, trade openness, lifestyle indicators and other covariates. The possible mediating effect of annual per capita intake of soft drinks, animal fats and total calories on the association between fast food consumption and BMI was also analysed. Two-stage least squares regression models were conducted, using economic freedom as an instrumental variable, to study the causal effect of fast food consumption on BMI.
After adjustment for covariates, each 1-unit increase in annual fast food transactions per capita was associated with an increase of 0.033 kg/m(2) in age-standardized BMI (95% confidence interval, CI: 0.013-0.052). Only the intake of soft drinks - not animal fat or total calories - mediated the observed association (β: 0.030; 95% CI: 0.010-0.050). Economic freedom was an independent predictor of fast food consumption (β: 0.27; 95% CI: 0.16-0.37). When economic freedom was used as an instrumental variable, the association between fast food and BMI weakened but remained significant (β: 0.023; 95% CI: 0.001-0.045).
Fast food consumption is an independent predictor of mean BMI in high-income countries. Market deregulation policies may contribute to the obesity epidemic by facilitating the spread of fast food.
Bulletin of the World Health Organisation 02/2014; 92(2):99-107A. · 5.11 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This paper estimates the pattern of private and public physician visits and hospitalisation by socioeconomic position in two countries in which private healthcare expenditure constitutes a different proportion of the total amount spent on health care: Britain and Spain. Private physician visits and private hospitalisations were quantitatively more important in Spain than in Britain. In both countries, the use of private services showed a direct socioeconomic gradient. In Spain, the use of public GPs and public specialists tends to favour the worst-off, but no significant differences were observed in public hospitalisation. In Britain, with some exceptions, no significant socioeconomic differences were observed in the use of public health care services. The different pattern observed in the use of public specialist services may be due to the high frequency of visits to private specialists in Spain.
Health & Place 10/2013; 25C:19-25. · 2.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The Cox conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration.
To overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders.
As expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM.
The CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.
BMC Medical Research Methodology 09/2013; 13(1):114. · 2.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cross-sectional evidence suggests associations between sleep duration and levels of the inflammatory markers, C-reactive protein and interleukin-6. This longitudinal study uses data from the London-based Whitehall II study to examine whether changes in sleep duration are associated with average levels of inflammation from 2 measures 5 years apart. Sleep duration (≤5, 6, 7, 8, ≥9 hours on an average week night) was assessed in 5,003 middle-aged women and men in 1991/1994 and 1997/1999. Fasting levels of C-reactive protein and interleukin-6 were measured in 1997/1999 and 2002/2004. Cross-sectional analyses indicated that shorter sleep is associated with higher levels of inflammatory markers. Longitudinal analyses showed that each hour per night decrease in sleep duration between 1991/1994 and 1997/1999 was associated with higher levels of C-reactive protein (8.1%) and interleukin-6 (4.5%) averaged across measures in 1997/1999 and 2002/2004. Adjustment for longstanding illness and major cardiometabolic risk factors indicated that disease processes may partially underlie these associations. An increase in sleep duration was not associated with average levels of inflammatory markers. These results suggest that both short sleep and reductions in sleep are associated with average levels of inflammation over a 5-year period.
American journal of epidemiology 06/2013; · 4.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To compare the prevalence of disabling low back pain (DLBP) and disabling wrist/hand pain (DWHP) among groups of workers carrying out similar physical activities in different cultural environments, and to explore explanations for observed differences, we conducted a cross-sectional survey in 18 countries. Standardised questionnaires were used to ascertain pain that interfered with everyday activities and exposure to possible risk factors in 12,426 participants from 47 occupational groups (mostly nurses and office workers). Associations with risk factors were assessed by Poisson regression. The 1-month prevalence of DLBP in nurses varied from 9.6% to 42.6%, and that of DWHP in office workers from 2.2% to 31.6%. Rates of disabling pain at the 2 anatomical sites covaried (r=0.76), but DLBP tended to be relatively more common in nurses and DWHP in office workers. Established risk factors such as occupational physical activities, psychosocial aspects of work, and tendency to somatise were confirmed, and associations were found also with adverse health beliefs and group awareness of people outside work with musculoskeletal pain. However, after allowance for these risk factors, an up-to 8-fold difference in prevalence remained. Systems of compensation for work-related illness and financial support for health-related incapacity for work appeared to have little influence on the occurrence of symptoms. Our findings indicate large international variation in the prevalence of disabling forearm and back pain among occupational groups carrying out similar tasks, which is only partially explained by the personal and socioeconomic risk factors that were analysed.
[Show abstract][Hide abstract] ABSTRACT: To explore definitions for multi-site pain, and compare associations with risk factors for different patterns of musculoskeletal pain, we analysed cross-sectional data from the Cultural and Psychosocial Influences on Disability (CUPID) study. The study sample comprised 12,410 adults aged 20-59 years from 47 occupational groups in 18 countries. A standardised questionnaire was used to collect information about pain in the past month at each of 10 anatomical sites, and about potential risk factors. Associations with pain outcomes were assessed by Poisson regression, and characterised by prevalence rate ratios (PRRs). Extensive pain, affecting 6-10 anatomical sites, was reported much more frequently than would be expected if the occurrence of pain at each site were independent (674 participants v 41.9 expected). In comparison with pain involving only 1-3 sites, it showed much stronger associations (relative to no pain) with risk factors such as female sex (PRR 1.6 v 1.1), older age (PRR 2.6 v 1.1), somatising tendency (PRR 4.6 v 1.3) and exposure to multiple physically stressing occupational activities (PRR 5.0 v 1.4). After adjustment for number of sites with pain, these risk factors showed no additional association with a distribution of pain that was widespread according to the frequently used American College of Rheumatology (ACR) criteria. Our analysis supports the classification of pain at multiple anatomical sites simply by the number of sites affected, and suggests that extensive pain differs importantly in its associations with risk factors from pain that is limited to only a small number of anatomical sites.
[Show abstract][Hide abstract] ABSTRACT: We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.
[Show abstract][Hide abstract] ABSTRACT: Despite international efforts to implement smoking bans, several national legislations still allow smoking and recommend mechanical systems, such as ventilation and air extraction, to eliminate secondhand smoke (SHS) health-related risks. We aimed to quantify the relative contribution of mechanical systems and smoking bans to SHS elimination.
A cross-sectional study was conducted in randomly selected establishments from 4 Mexican cities (3 with no ban). SHS exposure was assessed using nicotine passive monitors. Establishment characteristics, presence of mechanical systems, and enforcement of smoking policies were obtained through direct observation and self-report. Multilevel models were used to assess relative contributions to SHS reduction.
Compared with Mexico City, nicotine concentrations were 3.8 times higher in Colima, 5.4 in Cuernavaca, and 6.4 in Toluca. Mechanical systems were not associated with reduced nicotine concentrations. Concentration differences between cities were largely explained by the presence of smoking bans (69.1% difference reduction) but not by mechanical systems (-5.7% difference reduction).
Smoking bans represent the only effective approach to reduce SHS. Tobacco control regulations should stop considering mechanical systems as advisable means for SHS reduction and opt for complete smoking bans in public places.
Nicotine & Tobacco Research 03/2012; 14(3):282-9. · 2.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Low levels of safety climate and training have been associated with higher occurrence of occupational-related health outcomes; workplace violence and verbal abuse could be considered an early indicator of escalating psychological workplace violence. We examined whether low level of safety factors were associated with a higher prevalence of verbal abuse at the workplace.
We used data from a cross-sectional survey administered among a stratified random sample of 1,000 employees from 10 of the 29 public hospitals in Costa Rica. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using survey logistic regression models to estimate the association between safety factors and verbal abuse from the following sources: administrators, supervisors, patients, patients' relatives and coworkers.
There was a high prevalence of verbal abuse among the healthcare workforce from both external (i.e., patients and patients' relatives) and internal workplace sources (i.e., coworkers, supervisors and administrators). A low level of safety climate was associated with verbal abuse from all sources with associations ranging from verbal abuse from administrators (OR=6.07; 95%CI: 2.05-17.92) to verbal abuse from patients (OR=2.24; 95%CI: 1.23-4.09).
These results highlight the need to address organizational characteristics of the workplace that may increase the risk of verbal abuse for the future development of prevention interventions in this setting.
[Show abstract][Hide abstract] ABSTRACT: The CUPID (Cultural and Psychosocial Influences on Disability) study was established to explore the hypothesis that common musculoskeletal disorders (MSDs) and associated disability are importantly influenced by culturally determined health beliefs and expectations. This paper describes the methods of data collection and various characteristics of the study sample.
A standardised questionnaire covering musculoskeletal symptoms, disability and potential risk factors, was used to collect information from 47 samples of nurses, office workers, and other (mostly manual) workers in 18 countries from six continents. In addition, local investigators provided data on economic aspects of employment for each occupational group. Participation exceeded 80% in 33 of the 47 occupational groups, and after pre-specified exclusions, analysis was based on 12,426 subjects (92 to 1018 per occupational group). As expected, there was high usage of computer keyboards by office workers, while nurses had the highest prevalence of heavy manual lifting in all but one country. There was substantial heterogeneity between occupational groups in economic and psychosocial aspects of work; three- to five-fold variation in awareness of someone outside work with musculoskeletal pain; and more than ten-fold variation in the prevalence of adverse health beliefs about back and arm pain, and in awareness of terms such as "repetitive strain injury" (RSI).
The large differences in psychosocial risk factors (including knowledge and beliefs about MSDs) between occupational groups should allow the study hypothesis to be addressed effectively.
PLoS ONE 01/2012; 7(7):e39820. · 3.53 Impact Factor