Determinants of high annual sickness absence in older workers: a prospective cohort study in England (Health and Employment After Fifty study).

Abstract

To quantify contributions of health- and employment-related risk factors to high annual sickness absence (HASA) among a population-based cohort of older workers in England. Prospective cohort study. 24 general practices geographically dispersed across England. Men and women initially aged 50-64 years recruited as part of the Health and Employment After Fifty study. HASA, defined as a total of more than 20 days sickness absence over a 12-month interval. 4726 men and women were analysed, providing data on 15 333 12-month follow-up intervals. HASA was reported in 1003 (6.5%) follow-up intervals. In adjusted models, the aspects of health with the largest population-attributable fractions (PAFs) % were disabling musculoskeletal pain (25.4, 95% CI 21.2 to 29.3) and depression (11.3, 95% CI 6.1 to 16.2). Among long-term determinants of health, high body mass index had the greatest impact (PAF% 18.2, 95% CI 8.9 to 26.5). After allowance for health, high physical demands of work (PAF% 22.8) and eligibility for more generous sick pay (PAF% 25.8) made substantial contributions. Strategies to minimise avoidable sickness absence at older ages should prioritise: reversal of recent increases in disabling mental illness; encouragement of continued activity in workers with non-specific musculoskeletal pain, supported by modification of occupational tasks if needed; timely surgery for disabling osteoarthritis; reducing obesity; and increasing opportunities for placement in work that is less demanding physically. Further research is needed to clarify the impacts of generous sick pay on patterns of sickness absence.