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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 1999 Jul;53(7):399–407. doi: 10.1136/jech.53.7.399

Workplace as an origin of health inequalities

J Vahtera, P Virtanen, M Kivimaki, J Pentti
PMCID: PMC1756934  PMID: 10492732

Abstract

OBJECTIVE: To investigate the effect of the workplace on the socioeconomic gradient of sickness absence. DESIGN: Comparison of the relation between socioeconomic status and employee sickness absence in three different towns. SETTINGS: The towns of Raisio, Valkeakoski, and Nokia in Finland. They are equal in size and regional social deprivation indices, located in the neighbourhood of a larger city, and produce the same services to the inhabitants. SUBJECTS: All permanent local government employees from Raisio (n = 887), Valkeakoski (n = 972), and Nokia (n = 934) on the employer's registers during 1991 to 1993. MAIN OUTCOME MEASURES: Rates of short (1-3 days) and long (> 3 days) spells of sickness absence, irrespective of cause, and separately for infection, musculoskeletal disorder, and trauma. RESULTS: In blue collar male and female workers, compared with the same sex higher grade white collar workers, the age adjusted numbers of long sick leaves were 4.9 (95% CI 4.2, 5.8) and 2.8 (2.6, 3.1) times higher, respectively. The risk varied significantly between the towns, in men in relation to long sick leaves irrespective of cause and resulting from musculoskeletal disorders, and in women in relation to long leaves resulting from infection. The numbers of long sick leaves were 3.9 (95% CI 2.8, 5.4) times higher in blue collar male workers than in higher grade white collar male workers in Raisio, 4.9 (95% CI 3.8, 6.3) times higher in Valkeakoski, and 5.8 (95% CI 4.5, 7.5) times higher in Nokia. Sickness absence of blue collar employees differed most between the towns. The rates of long sick leaves in blue collar men were 1.46 times greater (95% CI 1.25, 1.72) in Valkeakoski and 1.85 times greater (95% CI 1.58, 2.16) in Nokia than in Raisio. In men, no significant differences were found between the towns as regards the numbers of long sick leaves of higher grade white collar male workers. The socioeconomic gradients differed more between the towns in men who had worked for four years or more in the same employment than in men who had worked for shorter periods. No consistent health gradients of socioeconomic status were evident for short sick leaves among either sex. CONCLUSIONS: In men and to a lesser extent in women, the workplace is significantly associated with health inequalities as reflected by medically certified sickness absence and the corresponding socioeconomic gradients of health.

 

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Selected References

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  1. Ben-Shlomo Y., Smith G. D. Deprivation in infancy or in adult life: which is more important for mortality risk? Lancet. 1991 Mar 2;337(8740):530–534. doi: 10.1016/0140-6736(91)91307-g. [DOI] [PubMed] [Google Scholar]
  2. Blaxter M. Evidence on inequality in health from a national survey. Lancet. 1987 Jul 4;2(8549):30–33. doi: 10.1016/s0140-6736(87)93062-5. [DOI] [PubMed] [Google Scholar]
  3. Bosma H., Marmot M. G., Hemingway H., Nicholson A. C., Brunner E., Stansfeld S. A. Low job control and risk of coronary heart disease in Whitehall II (prospective cohort) study. BMJ. 1997 Feb 22;314(7080):558–565. doi: 10.1136/bmj.314.7080.558. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Drever F., Whitehead M., Roden M. Current patterns and trends in male mortality by social class (based on occupation). Popul Trends. 1996 Winter;(86):15–20. [PubMed] [Google Scholar]
  5. Eames M., Ben-Shlomo Y., Marmot M. G. Social deprivation and premature mortality: regional comparison across England. BMJ. 1993 Oct 30;307(6912):1097–1102. doi: 10.1136/bmj.307.6912.1097. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ford G., Ecob R., Hunt K., Macintyre S., West P. Patterns of class inequality in health through the lifespan: class gradients at 15, 35 and 55 years in the west of Scotland. Soc Sci Med. 1994 Oct;39(8):1037–1050. doi: 10.1016/0277-9536(94)90375-1. [DOI] [PubMed] [Google Scholar]
  7. Kivimäki M., Vahtera J., Thomson L., Griffiths A., Cox T., Pentti J. Psychosocial factors predicting employee sickness absence during economic decline. J Appl Psychol. 1997 Dec;82(6):858–872. doi: 10.1037/0021-9010.82.6.858. [DOI] [PubMed] [Google Scholar]
  8. Klaukka T., Sievers K., Takala J. Epidemiology of rheumatic diseases in Finland in 1964-76. Scand J Rheumatol Suppl. 1982;47:5–13. [PubMed] [Google Scholar]
  9. Koskinen S., Martelin T. Why are socioeconomic mortality differences smaller among women than among men? Soc Sci Med. 1994 May;38(10):1385–1396. doi: 10.1016/0277-9536(94)90276-3. [DOI] [PubMed] [Google Scholar]
  10. Lundberg U., Mårdberg B., Frankenhaeuser M. The total workload of male and female white collar workers as related to age, occupational level, and number of children. Scand J Psychol. 1994 Dec;35(4):315–327. doi: 10.1111/j.1467-9450.1994.tb00956.x. [DOI] [PubMed] [Google Scholar]
  11. Luoto R., Pekkanen J., Uutela A., Tuomilehto J. Cardiovascular risks and socioeconomic status: differences between men and women in Finland. J Epidemiol Community Health. 1994 Aug;48(4):348–354. doi: 10.1136/jech.48.4.348. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Mackenbach J. P., Gunning-Schepers L. J. How should interventions to reduce inequalities in health be evaluated? J Epidemiol Community Health. 1997 Aug;51(4):359–364. doi: 10.1136/jech.51.4.359. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Mackenbach J. P., Kunst A. E., Cavelaars A. E., Groenhof F., Geurts J. J. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997 Jun 7;349(9066):1655–1659. doi: 10.1016/s0140-6736(96)07226-1. [DOI] [PubMed] [Google Scholar]
  14. Marmot M. G., Bosma H., Hemingway H., Brunner E., Stansfeld S. Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet. 1997 Jul 26;350(9073):235–239. doi: 10.1016/s0140-6736(97)04244-x. [DOI] [PubMed] [Google Scholar]
  15. Marmot M. G., Shipley M. J., Rose G. Inequalities in death--specific explanations of a general pattern? Lancet. 1984 May 5;1(8384):1003–1006. doi: 10.1016/s0140-6736(84)92337-7. [DOI] [PubMed] [Google Scholar]
  16. Marmot M. G., Smith G. D., Stansfeld S., Patel C., North F., Head J., White I., Brunner E., Feeney A. Health inequalities among British civil servants: the Whitehall II study. Lancet. 1991 Jun 8;337(8754):1387–1393. doi: 10.1016/0140-6736(91)93068-k. [DOI] [PubMed] [Google Scholar]
  17. Marmot M., Feeney A., Shipley M., North F., Syme S. L. Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. J Epidemiol Community Health. 1995 Apr;49(2):124–130. doi: 10.1136/jech.49.2.124. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Marmot M., Ryff C. D., Bumpass L. L., Shipley M., Marks N. F. Social inequalities in health: next questions and converging evidence. Soc Sci Med. 1997 Mar;44(6):901–910. doi: 10.1016/s0277-9536(96)00194-3. [DOI] [PubMed] [Google Scholar]
  19. Morrison C., Woodward M., Leslie W., Tunstall-Pedoe H. Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register. BMJ. 1997 Feb 22;314(7080):541–546. doi: 10.1136/bmj.314.7080.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. North F. M., Syme S. L., Feeney A., Shipley M., Marmot M. Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study. Am J Public Health. 1996 Mar;86(3):332–340. doi: 10.2105/ajph.86.3.332. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. North F., Syme S. L., Feeney A., Head J., Shipley M. J., Marmot M. G. Explaining socioeconomic differences in sickness absence: the Whitehall II Study. BMJ. 1993 Feb 6;306(6874):361–366. doi: 10.1136/bmj.306.6874.361. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Phillimore P., Beattie A., Townsend P. Widening inequality of health in northern England, 1981-91. BMJ. 1994 Apr 30;308(6937):1125–1128. doi: 10.1136/bmj.308.6937.1125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Power C., Matthews S. Origins of health inequalities in a national population sample. Lancet. 1997 Nov 29;350(9091):1584–1589. doi: 10.1016/S0140-6736(97)07474-6. [DOI] [PubMed] [Google Scholar]
  24. Smith G. D., Hart C., Blane D., Gillis C., Hawthorne V. Lifetime socioeconomic position and mortality: prospective observational study. BMJ. 1997 Feb 22;314(7080):547–552. doi: 10.1136/bmj.314.7080.547. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Vahtera J., Kivimäki M., Pentti J. Effect of organisational downsizing on health of employees. Lancet. 1997 Oct 18;350(9085):1124–1128. doi: 10.1016/S0140-6736(97)03216-9. [DOI] [PubMed] [Google Scholar]

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