文章基本信息

标题：Working While Ill as a Risk Factor for Serious Coronary Events: The Whitehall II Study
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作者：Mika Kivimäki ; Jenny Head ; Jane E. Ferrie 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2005
卷号：95
期号：1
页码：98-102
DOI：10.2105/AJPH.2003.035873
语种：English
出版社：American Public Health Association
摘要：Objectives. Although sick, some people take no time off work, a phenomenon called “sickness presenteeism.” This study examined the association between sickness presenteeism and incidence of serious coronary events. Methods. The analyses were based on a cohort of 5071 male British civil servants without previous myocardial infarction. Baseline screening included measurements of health status and coronary risk factors. Absence records were assessed for the 3 years subsequent to baseline screening. The outcome of interest was incident nonfatal myocardial infarction or fatal coronary heart disease (mean length of follow-up=9.1 years). Results. Seventeen percent of unhealthy employees took no absence during the 3-year follow-up. Their incidence of serious coronary events was twice as high as that of the unhealthy employees with moderate levels of sickness absenteeism (after adjustment for conventional risk factors, hazard ratio 1.97, 95% confidence interval=1.02, 3.83). Conclusions. Employers and employees should be aware of the potential harmful effects caused by sickness presenteeism. Absence from work because of sickness, or “sickness absenteeism,” is increasingly recognized as a measure of ill health. 1– 4 Studies on disease end points have shown that increased rates of medically certified periods of absence (long-term absences) predict increased rates of all-cause and cause-specific mortality, including cardiovascular death. 1, 3, 4 This implies that medically certified absence is a measure of ill health. For self-certified (short-term) sickness absenteeism, similar associations have not been observed. A recent report from the Whitehall II study on overall mortality suggested a slightly higher mortality risk among employees with no such absence from work than among those with moderate absence. 3 Findings on self-certified absence raise the possibility that some people, although sick, bring themselves to work and record no absences, a phenomenon called “sickness pre-senteeism.” 5– 7 Such behavior is hypothesized to be detrimental to health in the long run. 8 Absence provides scope for recovery for ill and distressed employees, whereas presenteeism could produce a cumulative stress burden, a risk factor for coronary heart disease. 9 However, no empirical data have been available to test this hypothesis. This study from the Whitehall II cohort examined associations between sickness absenteeism and incidence of serious coronary events, as indicated by first nonfatal myocardial infarction and fatal coronary heart disease. To examine the effects of sickness presenteeism, we stratified our analyses by health status. Among those healthy at baseline, we expected the incidence of serious coronary events to increase as the absence rate increased. Among those unhealthy at baseline, we expected to see a U-shaped association, with a higher incidence among employees with no absence than among those with moderate absence. This is because sickness presenteeism is most likely in an unhealthy group with no absences. High rates of absence, as a marker of serious health problems, 3 would be associated with a high incidence of coronary events.