Abstract
Objectives
To provide a wide and thorough description of sickness absence (SA) in Spain, focussing on the different regions of the country and the main characteristics of SA.
Methods
A study of the SA spells in Spain, managed by the medical units of the National Institute of Social Security in 2018. The geographical scope of this observational study is the regions (Autonomous Community). Incidence, prevalence, and average duration SA in employees and self-employed are described. The study also describes the differences between non-work-related SA and work-related SA. In age and sex variables, the incidence and the average duration are described. The average duration by Diagnostic Chapters (International Classification of Diseases, 10th Revision (ICD-10)) and the highest number of SA spells by occupational activity and diagnosis are analysed.
Results
A total of 540 045 SA spells are analysed by non-work-related SA and 63 441 by work-related SA. The national average prevalence in non-work-related SA spells is 32.98/1000 among employed and 30.48/1000 among self-employed; in work-related SA spells, the prevalence is 3.99/1000. The national incidence in non-work-related SA spells is 24.8/1000 for employees and 9.51/1000 for self-employed workers; in work-related SA spells the incidence is 3.55/1000. The average duration is 58.67 days, with the longest duration being neoplasms and the shortest corresponding to infectious disease. The Community of Madrid shows the lowest prevalence, incidence and average duration in work-related SA. Influenza is the diagnosis that generates the largest number of SA spells. Activities of call centres and temporary employment agency activities are the occupations that have the highest number of SA spells.
Conclusions
The biggest differences are found in the incidence and average duration, between the non-work-related SA spells and work-related SA. If those characteristics of the SA in which a region is more in deficit are known, it will be possible to do better management of the SA.
Keywords: preventive medicine, public health, occupational & industrial medicine
Strengths and limitations of this study.
The greatest strength of this study is the broad representativeness of its data.
The data used are at a national level, which allows a great perspective of sickness absence (SA) in Spain.
In this study, it has not always been possible to compare the data between employed and self-employed workers.
It has not always been possible to distinguish in this study between non-work-related and work-related in all SA spells.
SA spells lasting less than 4 days has not been included in this study.
Introduction
Sickness absence (SA) is one of the benefits of Social Security, included in article 169 of the Consolidated Text of the General Law of Social Security, RDL 8/2015 of 30th October. It comprises benefits in kind (medical assistance) and monetary compensations (benefits for SA). In Spain, there is a distinction between non-work-related SA (common disease and non-occupational accident) and work-related SA (professional illness and occupational accident). The differences between one group and the other can be seen both in the economic amount of the benefits due to sick leave and in the social security contributions. To be entitled to this subsidy, there must be medical examination and SA is certified by the family practitioner from the State Health Services, in case of common disease and non-occupational accident. If it is caused by occupational accidents or professional illness, this sick leave is certified by physicians ascribed to Insurance Companies linked to the Social Security system. Maximum duration of sick leave is 365 days, which can be extended for another 180 days if recovery and return of the worker to workplace are expected at that time. If the duration of sickness benefits has expired and the person’s state of health has not improved enough to return to work, the worker may receive a disability pension. The maximum duration of SA benefits is similar to other countries nearby such as Germany, Belgium or Austria. However, there are considerable differences in all European Union countries in terms of the amount of the payment and the requirements for receiving these benefits.1
Concerning the rest of the countries of the Organisation for Economic Co-operation and Development (OECD), Spain is in an intermediate position regarding the SA days per worker/year. Mexico is in the highest position with 27.7 days, whereas Chile, in the lowest position, has 7.3 days. Spain has an average of 10.3 days, which is similar to the level of Austria and the Netherlands (10 days) (https://stats.oecd.org/index.aspx?queryid=30123).
Like most European countries, Spain’s public sickness insurance spending is a major component of its social security system.1 The total financial cost of SA in consolidated Social Security budgets for 2019 in Spain reached 11 554 711.16 €, which is 8.89% of the general Social Security budget.2 Besides, the importance of SA caused by disease or accident is not only determined by the social and financial costs that each State dedicates to it,3 but also by the resources that employers assign to it,4 as well as the productivity losses5 and the deterioration of these workers’ health.6 It has been reported that work absenteeism due to illness is, in itself, a risk factor to fall sick, new periods of SA, unemployment, permanent disability pension,6–8 social exclusion9 and death.10–12 Long SA periods generate both an early retirement from the job market, a slower salary increase and an impoverishment of household wealth.6–9
Spain is divided into 17 regions. In each region there are significant differences in education, economic situation, unemployment rate and public health system. By sex, the percentage of men and women is balanced. The number of women is slightly higher, although the number of working men is still higher. By age, the regions with the youngest population are mainly those on the Mediterranean coast and also Castile La Mancha, Extremadura and the Community of Madrid. The northwestern regions are more aged.
In 2017 the working population rate in Spain was 59.41%. The regions with the highest rates of active population were the Canary Islands, the Balearic Islands, the Community of Madrid and Catalonia and those with the lowest rates were the Cantabrian, Western and Central regions. Service sector was the majority of the workforce (76%) in the islands, the Community of Madrid and Andalusia. Industry was the predominant sector in Navarre, the Basque Country and La Rioja; construction in Castile La Mancha; and agriculture and farming in Murcia (http://uvadoc.uva.es/handle/10324/26416)
These factors affect the behaviour of SA and their management in very different ways. It is important to know the differences to act accordingly.
Despite its relevance to public policies, there are few studies at the national level that describe the current situation of such benefits in our country; to date, the studies found in the literature related to this topic describe it partially,13 in some provinces or specific areas,14 about some specific diseases15 or specific groups of workers.16 The used data are national, representing the whole of the workers in Spain. It is a comprehensive and representative study of the total of SA spells in our country in 2018.
The general objective of this study is to provide a wide description of SA in Spain, focussing on the different regions of the country and according to the main characteristics of SA and differences between regions.
The specific objectives would be the description of the incidence, prevalence and average duration of SA; the description of the average duration and incidence rate about age and sex, as well as the average duration of SA by Diagnostic Chapters following the International Classification of Diseases, 10th Revision (ICD-10). The main occupational activities in which there are more workers with SA spells and the main diseases that cause more SA spells.
Material and methods
This study is carried out using the statistical databases provided by the Spanish National Institute of Social Security (INSS), which are published on the website of this organisation (www.seg-social.es/wps/portal/wss/internet/EstadisticasPresupuestosEstudios/), and databases obtained from specific programmes used by the Medical Units.
The reference population is formed by all the workers in Spain covered by the Social Security system in the year 2018. The study excludes the SA cases of Civil workers of the State, Armed Forces personnel and workers of the General Judicial Benefit Society, whose control and management are not an object of study. SA spells with a duration of fewer than 4 days are not included, because they do not obtain economic benefits from the Social Security system in Spain. Our study does not include unemployed workers, because they do not receive SA benefits
In Spain, our system of social security is contributory. To this end, both the worker and the company contribute to the system every month a sum of money (contribution) so that the worker can obtain benefits in case of illness or accident. If the worker is self-employed, it is himself who makes these economic contributions exclusively for non-work-related SA. This self-employed person also can pay voluntarily an extra amount for work-related SA to obtain benefits if he or she has a professional illness or an occupational accident.
Our database does not distinguish between employed and self-employed workers in the case of work-related SA. However, in non-work-related SA such division is made (table 1)
Table 1.
Prevalence, incidence and average duration of sickness absence in Spain (2018)
| Prevalence | Incidence | Average duration (days) | |||||||
| Non-work-related SA | Work-related SA | Non-work-related SA | Work-related SA | Non-work-related SA | Work-related SA | ||||
| Employed | Self-employed | Employed | Self-employed | Employed | Self-employed | ||||
| Andalusia | 29.41 | 31.43 | 4.26 | 19.72 | 9.28 | 3.98 | 44.79 | 98.35 | 37.24 |
| Aragon | 32.52 | 30.48 | 3.94 | 25.95 | 11.15 | 3.39 | 36.47 | 75.45 | 41.45 |
| Principality of Asturias | 36 | 38.96 | 5.01 | 18.73 | 10.85 | 3.53 | 58.55 | 105.03 | 47.08 |
| Balearic Islands | 31.29 | 21.7 | 4.72 | 27.02 | 6.46 | 5.15 | 33.02 | 84.01 | 30.94 |
| Canary Islands | 40.45 | 26.45 | 3.85 | 25.23 | 7.96 | 3.51 | 48.53 | 100.87 | 38.17 |
| Cantabria | 39.77 | 38.68 | 4.84 | 23.38 | 10.92 | 3.18 | 51.39 | 108.36 | 50.14 |
| Castile and Leon | 32.68 | 31.71 | 4.35 | 19.46 | 9.15 | 3.44 | 47.95 | 95.36 | 42.07 |
| Castile La Mancha | 32.4 | 35.57 | 4.48 | 19.91 | 9.93 | 3.96 | 46.02 | 98.54 | 38.08 |
| Catalonia | 35.14 | 28.76 | 3.8 | 36.37 | 10.17 | 3.6 | 28.54 | 83.48 | 36.06 |
| Extremadura | 31.59 | 38.9 | 4.64 | 12.76 | 8.94 | 3.68 | 67.53 | 112.86 | 41.42 |
| Galicia | 39.79 | 44.29 | 5.51 | 18.52 | 10.54 | 3.57 | 61.39 | 111.82 | 49.83 |
| Community of Madrid | 29.17 | 20.79 | 2.73 | 25.54 | 7.71 | 2.89 | 33.89 | 77.75 | 33.11 |
| Murcia | 35.55 | 40.63 | 4.12 | 20.21 | 11.33 | 3.39 | 48.39 | 98.49 | 40.2 |
| Chartered Community of Navarra | 35.73 | 30.72 | 4.28 | 43.87 | 16.46 | 3.88 | 24.64 | 55.15 | 37.86 |
| La Rioja | 27.3 | 25.65 | 4.41 | 25.28 | 10.91 | 3.91 | 34.53 | 69.95 | 38.87 |
| Valencia | 30.68 | 29.28 | 4.4 | 18.06 | 8.79 | 3.34 | 49.29 | 96.3 | 42.34 |
| Basque Country | 39.58 | 28.3 | 3.84 | 31.15 | 10.52 | 3.96 | 38.16 | 79.6 | 36.55 |
| National total | 32.98 | 30.48 | 3.99 | 24.98 | 9.51 | 3.55 | 38.81 | 91.38 | 38.23 |
SA, sickness absence.
Sample: The 2018 total SA records of the INSS is used, which coincide with the total population studied.
The variables used were: Age (in ranges), sex, average SA duration, diagnosis and diagnostic group (ICD-10), employee or self-employed, non-work-related SA (common disease non-occupational accident) or work-related SA (occupational accident and professional illness), and occupations with higher SA ranking according to the International Standard Industrial Classification of all Economic Activities (ISIC Rev-4).
The geographical scope of the study is the regions of Spain.
This is an observational study. The statistical calculations used to refer to all the people affiliated with the system who are entitled to receive the SA benefit (AFI), calculated according to the data provided by the Public Employment Service, the General Treasury of Social Security, INSS and the Social Institute of the Navy.
Incidence: The ratio that calculates the number of SA (MP2R) per 1000 affiliates. To compute the SA, the number of real registrations for the benefit (MP2R) is used. Monthly datum: MP2R×1000/AFI. Accumulated datum: average (MP2R)×1000/AFI.
Prevalence: The ratio that calculates the number of SA processes in force per 1000 affiliates. To compute the processes in force, the number of perceivers at the end of the period (MP4) is used. Monthly datum: MP4×1000/AFI. Accumulated datum: average (MP4)×1000/AFI.
The mean general duration is the average of all durations per year. The mean duration per age range and sex were calculated by dividing the number of days in SA by the number of workers in SA in that range. It is also described the number of workers in SA per 1000 affiliates. The median for the average duration per diagnostic chapter is calculated, using the statistics software Excel.
Patient and public involvement
Anonymised patient data are used in this study. Patients and members of the public are not involved in the conducting of the study.
Results
A total of 540 045 non-work-related SA spells and 63 441 work-related SA spells is analysed, which are those controlled by the Medical Units of the Spanish National Institute of Social Security. There is a total of 16 373 239 workers affiliated to social security.
The age of the study participants is 16 to 70 years old, both men and women. All are included in all the variables studied (non-work-related, work-related, employed, self-employed, sex, age, diagnosis and occupational activities). Follow-up time is 1 year (2018).
Our results are:
SA prevalence
The prevalence of non-work-related SA is 32.68/1000, among employed and 30.48/1000 among self-employed. Prevalence of work-related is 3.99/1000. In the non-work-related, it ranges between 27.3 in La Rioja and 40.45 in the Canary Islands in employed persons. In self-employed, it ranges between 21.5 in the Balearic Islands and 40.63 in the Region of Murcia. In work-related SA, it ranges from 2.73 in the Community of Madrid to 5.51 in Galicia (table 1).
SA incidence
Incidence of non-work-related was 24.87/1000 among employed and 9.51/1000 among self-employed. The incidence of work-related was 3.55/1000. Its values ranged between 12.76 in Extremadura and 36.7 in Catalonia (non-work-related, employed person); for self-employed it ranged between 7.71 in Community of Madrid and 16.46 in Chartered Community of Navarre (non-work-related SA). In work-related SA, it ranged from 2.89 in Madrid to 5.15 in the Balearic Islands (table 1).
Average SA duration
The average duration of SA was 58.67 days (in non-work-related SA from 38.81 days among employed to 91.38 days among self-employed) with a median of 48.53 days. In non-work-related SA for employees, it ranged between 24.64 days in Chartered Community of Navarre to 67.53 in Extremadura. For self-employed, it varied between 55.15 days in Navarra to 112.86 days in Extremadura. In work-related SA, it ranged from 30.94 days in the Balearic Islands to 50.14 in Cantabria (table 1).
SA spells and average duration (age ranges and sex)
In table 2, the total number of workers on sick leave by age and sex is analysed. There is a distinction between the absolute number of workers on SA and the number of workers on SA per 1000 affiliated per age group and gender because in Spain, in almost all age groups there are more men than women affiliated to social security. This may result in more absolute numbers of sickness absence for men, although the number of SA is higher for women according to the number of affiliates.
Table 2.
Sickness absence (SA) and average duration (days), by age and sex
| Andalusia | Aragon | Principality of Asturias | Balearic Islands | Canary islands | Cantabria | Castile and Leon | Castile La Mancha | Catalonia | Extremadura | Galicia | Community of Madrid | Region of Murcia | CharteredCommunity of Navarre | La Rioja | Valencia | Basque Country | |||||||||||||||||||
| Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | Woman | Man | ||
| Total workforce | 28 519 | 30 319 | 7211 | 9576 | 1836 | 2100 | 11 010 | 10 470 | 11 404 | 9813 | 2235 | 2292 | 6859 | 9934 | 7294 | 10 106 | 92 204 | 83 921 | 2064 | 2793 | 6082 | 7549 | 43 592 | 42 510 | 5649 | 7818 | 5488 | 7886 | 1457 | 2034 | 15 154 | 18 327 | 8401 | 12 209 | |
| Average affiliated workers | 68 552.40 | 89 788.42 | 12 715.03 | 17 792.34 | 5368.35 | 6294.17 | 16 392.26 | 19 260.69 | 19 549.26 | 23 478.52 | 3792.28 | 4565.60 | 16 025.01 | 22 400.00 | 13 405.17 | 21 951.23 | 112 945.81 | 122 308.48 | 7057.99 | 11 732.44 | 17 279.67 | 21 582.01 | 81 635.82 | 97 705.09 | 13 971.74 | 19 847.78 | 6659.14 | 8653.16 | 2699.60 | 2696.28 | 46 147.56 | 56 875.39 | 17 735.00 | 22 613.08 | |
| 16–25 | SA/1000 affiliates | 34.67 | 28.14 | 47.26 | 44.85 | 28.5 | 27.8 | 55.97 | 45.29 | 48.61 | 34.82 | 49.11 | 41.83 | 35.67 | 36.96 | 45.34 | 38.36 | 68.02 | 57.17 | 24.37 | 19.83 | 29.33 | 29.14 | 44.5 | 36.25 | 33.69 | 32.82 | 68.67 | 75.94 | 44.97 | 45.85 | 27.36 | 26.85 | 39.47 | 44.99 |
| Total days of SA | 834 572 | 846 610 | 131 509 | 167 205 | 50 471 | 56 482 | 185 291 | 178 221 | 309 354 | 231 868 | 48 036 | 48 391 | 167 468 | 222 267 | 309 354 | 242 410 | 1 358 613 | 1 249 511 | 94 375 | 105 025 | 231 248 | 264 978 | 659 008 | 707 760 | 189 971 | 225 126 | 70 415 | 105 159 | 26 249 | 38 326 | 434 028 | 500 328 | 170 994 | 232 766 | |
| Average duration | 29 | 27 | 18 | 17 | 27 | 26 | 16 | 17 | 27 | 23 | 21 | 21 | 24 | 22 | 42 | 23 | 14 | 14 | 45 | 37 | 38 | 35 | 15 | 16 | 33 | 28 | 12 | 13 | 18 | 18 | 28 | 27 | 20 | 19 | |
| Total workforce | 100 686 | 86 518 | 20 411 | 20 921 | 7876 | 8438 | 22 333 | 19 262 | 32 182 | 25 520 | 7126 | 6214 | 23 829 | 23 851 | 22 958 | 23 179 | 195 844 | 166 163 | 8168 | 6905 | 25 440 | 23 811 | 126 980 | 102 745 | 19 347 | 18 506 | 5488 | 7886 | 1457 | 2034 | 15 154 | 18 327 | 8401 | 12 209 | |
| Average affiliated workers | 300 358.69 | 330 969.33 | 48 943.45 | 55 044.50 | 29 131.98 | 30 748.08 | 51 679.23 | 54 743.11 | 80 321.79 | 82 314.91 | 18 686.80 | 19 468.05 | 73 916.47 | 83 188.54 | 59 795.11 | 75 578.35 | 310 001.82 | 347 500.15 | 36 076.74 | 41 472.33 | 88 778.42 | 92 930.24 | 334 003.39 | 351 427.98 | 53 485.35 | 64 162.37 | 23 761.08 | 27 464.21 | 11 184.28 | 11 558.26 | 169 672.13 | 189 654.50 | 72 276.88 | 83 898.41 | |
| 26–35 | SA/1000 affiliates | 27.93 | 21.78 | 34.75 | 31.67 | 22.53 | 22.87 | 36.01 | 29.32 | 33.39 | 25.84 | 31.78 | 26.60 | 26.86 | 23.89 | 32.00 | 25.55 | 52.65 | 39.85 | 18.87 | 13.87 | 23.88 | 21.35 | 31.68 | 24.36 | 30.14 | 24.04 | 52.48 | 51.62 | 33.13 | 36.82 | 24.45 | 19.81 | 37.83 | 34.70 |
| Total days of SA | 4 002 601 | 2 741 036 | 613 970 | 475 288 | 326 129 | 321 994 | 596 265 | 434 597 | 1 290 175 | 833 828 | 282 294 | 203 621 | 918 856 | 733 947 | 927 034 | 686 484 | 4 915 171 | 3 405 555 | 475 765 | 307 251 | 1 289 570 | 1 018 756 | 3 636 681 | 2 344 947 | 882 767 | 621 458 | 325 739 | 275 255 | 127 536 | 108 671 | 2 207 518 | 1 512 322 | 1 228 249 | 847 290 | |
| Average duration | 39 | 31 | 30 | 22 | 41 | 38 | 26 | 22 | 40 | 32 | 39 | 32 | 38 | 30 | 40 | 29 | 25 | 20 | 58 | 44 | 50 | 42 | 28 | 22 | 45 | 33 | 21 | 16 | 28 | 21 | 44 | 33 | 35 | 24 | |
| Total workforce | 118 614 | 117 512 | 25 565 | 26 492 | 13 494 | 14 020 | 23 709 | 22 637 | 40 199 | 35 601 | 10 016 | 9757 | 31 594 | 32 035 | 26 742 | 29 050 | 221 680 | 205 633 | 9621 | 9250 | 38 674 | 35 964 | 151 187 | 125 041 | 23 103 | 24 813 | 20 685 | 22 630 | 5864 | 6555 | 63 233 | 65 615 | 51 452 | 55 641 | |
| Average affiliated workers | 416 547.17 | 493 349.53 | 73 820.89 | 88 587.25 | 53 033.04 | 57 508.87 | 72 634.45 | 79 189.07 | 113 319.60 | 124 332.39 | 31 436.56 | 34 354.87 | 116 512.04 | 134 105.28 | 85 921.38 | 117 415.38 | 467 172.39 | 536 140.86 | 51 846.68 | 57 864.40 | 154 779.30 | 159 073.44 | 448 746.41 | 492 003.79 | 74 900.72 | 103 493.33 | 37 428.06 | 44 884.12 | 18 530.51 | 19 654.64 | 256 013.07 | 308 714.88 | 131 005.73 | 147 561.07 | |
| 36–45 | SA/1000 affiliates | 23.73 | 19.85 | 28.86 | 24.92 | 21.20 | 20.32 | 27.20 | 23.82 | 29.56 | 23.86 | 26.55 | 23.67 | 22.60 | 19.91 | 25.94 | 20.62 | 39.54 | 31.96 | 15.46 | 13.32 | 20.82 | 18.84 | 28.08 | 21.18 | 25.70 | 19.98 | 46.06 | 42.02 | 26.37 | 27.79 | 20.58 | 17.71 | 32.73 | 31.42 |
| Total days of SA | 5 485 098 | 4 853 604 | 1 017 787 | 884 342 | 729 537 | 710 147 | 871 595 | 690 262 | 1 994 219 | 1 537 765 | 522 327 | 427 368 | 1 601 141 | 1 341 221 | 1 320 806 | 1 180 792 | 7 299 940 | 5 952 905 | 684 002 | 523 399 | 2 405 243 | 1 925 240 | 5 625 202 | 4 022 176 | 1 271 496 | 1 132 594 | 584 891 | 515 533 | 216 891 | 196 201 | 3 345 778 | 2 905 621 | 2 137 768 | 1 898 819 | |
| Average duration | 46 | 41 | 39 | 33 | 54 | 50 | 36 | 30 | 49 | 43 | 52 | 43 | 50 | 41 | 49 | 40 | 32 | 28 | 71 | 56 | 62 | 53 | 37 | 32 | 55 | 45 | 28 | 22 | 36 | 29 | 52 | 44 | 41 | 34 | |
| Total workforce | 93 419 | 97 446 | 20 531 | 21 134 | 12 107 | 11 379 | 19 560 | 18 340 | 33 484 | 32 340 | 7739 | 7993 | 27 137 | 28 786 | 20 740 | 24 528 | 161 373 | 145 283 | 9133 | 9654 | 32 304 | 30 656 | 116 428 | 97 152 | 17 870 | 19 928 | 17 679 | 17 432 | 4652 | 5523 | 52 477 | 56 490 | 44 669 | 47 083 | |
| Average affiliated workers | 376 667.85 | 452 781.53 | 72 642.41 | 86 832.17 | 50 430.1 | 54 182.72 | 59 519.62 | 70 647.25 | 103 329.08 | 124 900.1 | 27 966.17 | 32 274.09 | 121 691.32 | 144 244.47 | 78 676.23 | 113 500.26 | 420 095.39 | 483 766.12 | 48 959.11 | 61 304.89 | 155 675.61 | 146 483 | 392 653.45 | 435 113.09 | 63 760.45 | 88 653.91 | 36 669.67 | 43 790.26 | 16 865.87 | 19 151.91 | 227 708.97 | 286 020.66 | 132 334.79 | 149 918.57 | |
| 46–55 | SA/1000 affiliates | 20.67 | 17.93 | 23.55 | 20.28 | 20.01 | 17.50 | 27.39 | 21.63 | 27.00 | 21.58 | 23.06 | 20.64 | 18.58 | 16.63 | 21.97 | 18.01 | 32.01 | 25.03 | 15.55 | 13.12 | 17.29 | 17.44 | 24.71 | 18.61 | 23.36 | 18.73 | 40.18 | 33.17 | 22.99 | 24.03 | 19.20 | 16.46 | 28.13 | 26.17 |
| Total days of SA | 5 669 205 | 5 761 219 | 1 161 473 | 1 064 204 | 892 531 | 800 712 | 986 970 | 817 858 | 2 095 638 | 1 869 968 | 514 677 | 492 931 | 1 843 156 | 1 685 686 | 1 339 820 | 1 442 138 | 7 170 290 | 6 146 120 | 756 791 | 756 088 | 2 592 300 | 2 196 003 | 5 597 323 | 4 348 939 | 1 266 827 | 1 234 944 | 690 509 | 631 366 | 226 762 | 248 332 | 3 621 543 | 3 415 316 | 2 402 084 | 2 300 411 | |
| Average duration | 60 | 59 | 56 | 50 | 73 | 70 | 50 | 44 | 62 | 57 | 66 | 61 | 67 | 58 | 64 | 58 | 44 | 42 | 82 | 78 | 80 | 71 | 48 | 44 | 70 | 61 | 39 | 36 | 48 | 44 | 69 | 60 | 53 | 48 | |
| Total workforce | 54 794 | 55 337 | 13 132 | 12 022 | 9140 | 7504 | 11 512 | 9850 | 16 303 | 15 530 | 5491 | 5206 | 18 430 | 19 782 | 11 693 | 14 709 | 85 972 | 74 294 | 6060 | 6574 | 22 907 | 19 711 | 67 732 | 53 708 | 11 580 | 11 798 | 9312 | 8423 | 2931 | 3133 | 33 820 | 33 628 | 28 812 | 26 181 | |
| Average affiliated workers | 225 629.08 | 261 355.04 | 45 478.18 | 56 875.03 | 34 528.21 | 37 293.19 | 34 180.32 | 40 291.24 | 48 415.01 | 64 110.82 | 18 313.97 | 22 216.8 | 81 337.65 | 106 472.69 | 44 685.46 | 72 066.5 | 237 960.81 | 279 504.05 | 30 888.53 | 42 159.4 | 87 344.91 | 92 663.59 | 217 723.25 | 240 497.55 | 35 155.93 | 48 115.93 | 21 505.51 | 26 507.11 | 10 467.84 | 13 056.28 | 128 808.03 | 166 094.89 | 82 120.99 | 95 280.63 | |
| 56–65 | SA/1000 affiliates | 20.24 | 17.64 | 24.06 | 17.61 | 22.06 | 16.77 | 28.07 | 20.37 | 28.06 | 20.19 | 24.99 | 19.53 | 18.88 | 15.48 | 21.81 | 17.01 | 30.11 | 22.15 | 16.35 | 12.99 | 21.85 | 17.73 | 25.93 | 18.61 | 27.45 | 20.43 | 36.08 | 26.48 | 23.33 | 20.00 | 21.88 | 16.87 | 29.24 | 22.90 |
| Total days of SA | 4 016 323 | 4 392 212 | 954 029 | 886 164 | 799 503 | 654 003 | 722 340 | 644 055 | 1 270 661 | 1 239 034 | 458 470 | 446 106 | 1 611 454 | 1 563 351 | 971 777 | 1 205 977 | 5 269 955 | 4 690 436 | 567 570 | 631 405 | 2 297 445 | 1 810 405 | 4 144 067 | 3 305 759 | 1 026 123 | 969 808 | 478 852 | 457 600 | 200 637 | 200 286 | 2 884 959 | 2 773 183 | 2 023 474 | 1 882 291 | |
| Average duration | 73 | 79 | 72 | 73 | 87 | 87 | 62 | 65 | 77 | 79 | 83 | 85 | 87 | 79 | 83 | 81 | 61 | 63 | 95 | 96 | 100 | 91 | 61 | 61 | 88 | 82 | 51 | 54 | 68 | 63 | 85 | 82 | 70 | 71 | |
| Total workforce | 1009 | 912 | 218 | 229 | 143 | 135 | 248 | 248 | 405 | 507 | 93 | 90 | 309 | 369 | 222 | 243 | 1499 | 1783 | 109 | 118 | 496 | 416 | 1427 | 1472 | 209 | 205 | 97 | 99 | 48 | 53 | 565 | 586 | 395 | 395 | |
| Average affiliated workers | 11 950.42 | 13 802.04 | 2562.05 | 3147.87 | 2035.13 | 1864.38 | 2749.35 | 3794.28 | 3761 | 6238.89 | 1063.87 | 1151.9 | 4800.68 | 6608.46 | 2729.33 | 3896.45 | 16 654.52 | 21595.24 | 1635.76 | 2118.84 | 6019.34 | 6010.7 | 14 815.19 | 17 812.54 | 2137.48 | 2850.03 | 976.63 | 1251.16 | 558.86 | 884.86 | 7419.14 | 9562.67 | 3943.04 | 4299.16 | |
| >65 | SA/1000 affiliates | 7.04 | 5.51 | 7.09 | 6.06 | 5.86 | 6.03 | 7.52 | 5.45 | 8.97 | 6.77 | 7.28 | 6.51 | 5.36 | 4.65 | 6.78 | 5.20 | 7.50 | 6.88 | 5.55 | 4.64 | 6.87 | 5.77 | 8.03 | 6.89 | 8.15 | 5.99 | 8.28 | 6.59 | 7.16 | 4.99 | 6.35 | 5.11 | 8.35 | 7.66 |
| Total days of SA | 102 994 | 86 720 | 22 938 | 20 767 | 14 254 | 15 093 | 19 474 | 21 387 | 42 070 | 54 105 | 9941 | 8986 | 33 554 | 36 135 | 30 606 | 23 582 | 137 904 | 164 426 | 14 652 | 13 172 | 60 119 | 49 220 | 115 468 | 116 354 | 28 423 | 19 951 | 7095 | 8826 | 5266 | 4674 | 63 313 | 59 850 | 38 371 | 34 999 | |
| Average duration | 102 | 95 | 105 | 90 | 99 | 111 | 78 | 86 | 103 | 106 | 106 | 99 | 108 | 97 | 137 | 97 | 91 | 92 | 134 | 111 | 121 | 118 | 80 | 79 | 135 | 97 | 73 | 89 | 109 | 88 | 112 | 102 | 97 | 88 | |
SA, sickness absence.
Therefore, the total number of workers in SA by age and sex is higher in men than in women (table 2). According to age range and sex, the number of affiliates in SA is higher in women, except in Castilla and Leon, Chartered Community of Navarre and the Basque Country between 16 and 25 years of age, Principality of Asturias and La Rioja between 26 and 35 years and La Rioja in 36 to 45 and 46 to 55 years.
The average duration of SA is also higher in women than in men in all the age ranges, except in the Community of Madrid and La Rioja for 16 to 25 years, and Principality of Asturias, Balearic Islands, Canary Islands, Catalonia and Chartered Community of Navarre in workers over 65 years of age.
In women, the average duration of SA is 58.5 days (minimum 12 and maximum 137), with a median of 52 days. In men, the average is 53.08 days (minimum 13 and maximum 118), with a median of 44.
Average SA duration (diagnostic chapter)
The average SA duration, in general, is 56.82 days, with a median of 52.80 days. In all the regions Communities, the longest duration corresponds to neoplasms, followed by heart diseases and mental disorders. The shortest duration corresponds to infectious diseases (table 3).
Table 3.
Average duration (days) by diagnostic chapter (ICD-10)
| Diagnosis chapter (1) | Andalusia | Aragon | Principality of Asturias | Balearic Islands | Canary Islands | Cantabria | Castile and leon | CASTILE Castile la Mancha | Catalonia | Extremadura | Galicia | Community of Madrid | Region of Murcia | CharteredCommunity of Navarre | La Rioja | Valencia | Basque country | Average duration (DAYS) |
| (I) Certain infectious and parasitic diseases | 14.91 | 7.87 | 9.33 | 5.50 | 9.13 | 6.40 | 14.69 | 14.89 | 5.09 | 16.92 | 17.39 | 6.58 | 8.03 | 3.87 | 4.69 | 9.50 | 9.19 | 9.65 |
| (II) Neoplasms | 109.78 | 120.16 | 131.05 | 123.93 | 102.69 | 113.30 | 124.41 | 131.66 | 99.47 | 136.05 | 134.20 | 87.92 | 109.89 | 105.09 | 104.53 | 121.97 | 142.86 | 117.59 |
| (III) Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism | 91.98 | 97.53 | 76.71 | 61.03 | 83.72 | 57.30 | 76.59 | 83.38 | 63.33 | 121.10 | 94.43 | 63.74 | 89.23 | 40.54 | 58.16 | 85.98 | 108.07 | 79.58 |
| (IV) Endocrine, nutritional and metabolic diseases | 72.54 | 67.72 | 66.06 | 50.60 | 64.70 | 81.62 | 57.53 | 72.88 | 59.03 | 78.47 | 88.73 | 56.96 | 81.66 | 43.03 | 48.54 | 71.53 | 81.06 | 67.22 |
| (V) Mental and behavioural disorders | 95.17 | 90.37 | 99.28 | 56.11 | 83.26 | 111.34 | 95.30 | 94.54 | 72.03 | 114.42 | 110.52 | 78.88 | 111.86 | 65.66 | 70.64 | 98.46 | 116.66 | 92.03 |
| (VI) Diseases of the nervous system | 79.81 | 61.81 | 85.12 | 49.46 | 70.50 | 65.51 | 78.55 | 74.37 | 44.98 | 80.11 | 95.84 | 54.49 | 78.03 | 26.40 | 44.64 | 79.21 | 70.51 | 67.02 |
| (VII) Diseases of the eye and adnexa | 44.13 | 42.99 | 47.85 | 28.72 | 40.94 | 45.41 | 45.05 | 44.12 | 29.17 | 56.76 | 48.63 | 29.62 | 46.43 | 18.80 | 29.77 | 41.70 | 45.77 | 40.35 |
| (VIII) Diseases of the ear and mastoid process | 33.04 | 26.90 | 33.55 | 18.33 | 31.33 | 29.05 | 27.30 | 26.82 | 18.89 | 47.66 | 42.55 | 21.63 | 35.98 | 13.85 | 18.54 | 29.13 | 37.40 | 28.94 |
| (IX) Diseases of the circulatory system | 103.40 | 107.05 | 102.25 | 85.73 | 90.19 | 108.21 | 99.35 | 104.24 | 79.86 | 106.57 | 111.53 | 76.86 | 112.64 | 80.66 | 90.12 | 101.52 | 119.39 | 98.8 |
| (X) Diseases of the respiratory system | 11.98 | 10.67 | 14.22 | 9.05 | 12.46 | 11.07 | 13.02 | 13.47 | 8.27 | 19.76 | 16.42 | 9.70 | 12.34 | 6.40 | 7.68 | 11.87 | 17.11 | 12.09 |
| (XI) Diseases of the digestive system | 30.65 | 35.44 | 44.16 | 28.59 | 39.97 | 43.95 | 21.86 | 35.59 | 27.19 | 50.51 | 47.53 | 32.56 | 41.01 | 14.97 | 30.98 | 40.84 | 37.32 | 35.48 |
| (XII) Diseases of the skin and subcutaneous tissue | 36.37 | 29.84 | 46.22 | 24.18 | 35.30 | 42.96 | 37.86 | 37.34 | 25.36 | 39.37 | 47.80 | 28.91 | 39.30 | 20.61 | 27.26 | 33.74 | 51.91 | 35.55 |
| (XIII) Diseases of the musculoskeletal system and connective tissue | 70.24 | 66.93 | 79.55 | 50.35 | 65.45 | 75.67 | 70.00 | 71.17 | 54.13 | 85.89 | 85.54 | 56.26 | 73.79 | 43.11 | 52.76 | 71.05 | 92.61 | 68.5 |
| (XIV) Diseases of the genitourinary system | 40.71 | 31.78 | 44.27 | 25.30 | 35.36 | 34.11 | 35.01 | 33.76 | 27.97 | 46.14 | 45.16 | 31.83 | 43.51 | 15.56 | 32.25 | 37.08 | 52.86 | 36.04 |
| (XV) Pregnancy, childbirth and the puerperium | 76.91 | 53.45 | 51.51 | 53.46 | 81.32 | 61.09 | 59.29 | 72.56 | 63.73 | 70.08 | 68.09 | 51.74 | 73.30 | 60.24 | 57.10 | 73.43 | 67.00 | 64.37 |
| (XVII) Congenital malformations, deformations and chromosomal abnormalities | 86.30 | 69.19 | 56.00 | 73.00 | 86.22 | 121.65 | 80.30 | 107.03 | 61.09 | 94.00 | 99.25 | 41.00 | 75.00 | 50.00 | 37.76 | 71.33 | 90.33 | 81.25 |
| (XVIII) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified | 36.13 | 29.88 | 38.00 | 23.00 | 26.00 | 42.50 | 33.23 | 36.11 | 20.82 | 38.50 | 37.25 | 28.00 | 51.00 | 9.00 | 28.45 | 31.67 | 37.67 | 32.19 |
| (XIX) Injury, poisoning and certain other consequences of external causes | 59.88 | 59.12 | 72.00 | 45.00 | 59.00 | 69.17 | 66.63 | 52.48 | 53.12 | 70.00 | 71.75 | 55.00 | 65.00 | 45.00 | 53.45 | 58.67 | 81.00 | 60.96 |
*Chapters XX, XXI and XXII are not included because the number of cases is not significant.
ICD-10, International Classification of Diseases, 10th Revision.
SA spells by ICD-10 diagnosis
Table 4 describes the main diagnoses that generate the highest numbers of SA spells/1000 affiliates/per month. The diagnoses with the highest number of SA were: Influenza, virus not identified, lower back pain and non-infective gastroenteritis and colitis, unspecified. They highlighted the multiple SA spells per non-infective gastroenteritis and colitis diagnosis, unspecific on Catalonia, Balearic Islands and Community of Navarre.
Table 4.
Sickness absence spells by diagnosis (ICD-10)
| Autonomous community of Spain | Code | Diagnosis | SA /1000 affiliates/per month |
| Andalusia | M54.5 | Low back pain | 1.36 |
| K52 | Other non-infective gastroenteritis and colitis | 1.00 | |
| J00 | Acute nasopharyngitis (common cold) | 0.83 | |
| J11 | Influenza, virus not identified | 0.82 | |
| M54.2 | Cervicalgia | 0.57 | |
| M54.3 | Sciatica | 0.52 | |
| J02.9 | Acute pharyngitis, unspecified | 0.40 | |
| J03.9 | Acute tonsillitis, unspecified | 0.38 | |
| Aragon | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 1.94 |
| J11 | Influenza, virus not identified | 1.28 | |
| M54.5 | Low back pain | 1.16 | |
| J02.9 | Acute pharyngitis, unspecified | 0.97 | |
| M25 | Other joint disorders, not elsewhere classified | 0.76 | |
| M54.3 | Sciatica | 0.42 | |
| M54.2 | Cervicalgia | 0.41 | |
| F41 | Other anxiety disorders | 0.38 | |
| Principality of Asturias | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 1.03 |
| M54.5 | Low back pain | 0.83 | |
| F41 | Other anxiety disorders | 0.80 | |
| J11 | Influenza, virus not identified | 0.55 | |
| M54.3 | Sciatica | 0.46 | |
| M54.2 | Cervicalgia | 0.40 | |
| J02.9 | Acute pharyngitis, unspecified | 0.30 | |
| M23 | Internal derangement of knee | 0.29 | |
| Balearic Islands | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 2.29 |
| M54.5 | Low back pain | 1.61 | |
| B97.8 | Other viral agents as the cause of diseases classified to other chapters | 1.26 | |
| J11 | Influenza, virus not identified | 1.15 | |
| F41.9 | Anxiety disorder, unspecified | 0.77 | |
| J03.9 | Acute tonsillitis, unspecified | 0.72 | |
| J00 | Acute nasopharyngitis (common cold) | 0.60 | |
| M54.3 | Sciatica | 0.60 | |
| Canary Islands | M54.5 | Low back pain | 1.40 |
| J11 | Influenza, virus not identified | 1.16 | |
| K52.9 | Non-infective gastroenteritis and colitis, unspecified | 1.02 | |
| J00 | Acute nasopharyngitis (common cold) | 0.82 | |
| J20.9 | Acute bronchitis, unspecified | 0.59 | |
| F06.4 | Organic anxiety disorder | 0.57 | |
| M54.3 | Sciatica | 0.51 | |
| M54.2 | Cervicalgia | 0.44 | |
| Cantabria | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 1.64 |
| J11 | Influenza, virus not identified | 1.13 | |
| M54.5 | Low back pain | 0.98 | |
| R45 | Symptoms and signs involving emotional state | 0.69 | |
| J02.9 | Acute pharyngitis, unspecified | 0.67 | |
| J06 | Acute upper respiratory infections of multiple and unspecified sites | 0.66 | |
| M54.3 | Sciatica | 0.61 | |
| M54.2 | Cervicalgia | 0.57 | |
| Castile and Leon | M54.5 | Low back pain | 1.28 |
| J11 | Influenza, virus not identified | 0.86 | |
| F41.9 | Anxiety disorder, unspecified | 0.53 | |
| M54.3 | Sciatica | 0.52 | |
| J98.8 | Other specified respiratory disorders | 0.40 | |
| J06.9 | Acute upper respiratory infection, unspecified | 0.37 | |
| J00 | Acute nasopharyngitis (common cold) | 0.30 | |
| K52 | Other non-infective gastroenteritis and colitis | 0.10 | |
| Castile La Mancha | M54.5 | Low back pain | 1.22 |
| K52.9 | Non-infective gastroenteritis and colitis, unspecified | 0.79 | |
| J00 | Acute nasopharyngitis (common cold) | 0.62 | |
| J11 | Influenza, virus not identified | 0.53 | |
| K52 | Other non-infective gastroenteritis and colitis | 0.50 | |
| J03.9 | Acute tonsillitis, unspecified | 0.43 | |
| M54.2 | Cervicalgia | 0.39 | |
| M54.3 | Sciatica | 0.37 | |
| Catalonia | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 2.82 |
| J00 | Acute nasopharyngitis (common cold) | 2.09 | |
| M54.5 | Low back pain | 1.96 | |
| J11 | Influenza, virus not identified | 1.58 | |
| F41.9 | Anxiety disorder, unspecified | 1.40 | |
| B97.8 | Other viral agents as the cause of diseases classified to other chapters | 1.05 | |
| J03.9 | Acute tonsillitis, unspecified | 0.85 | |
| M54.2 | Cervicalgia | 0.68 | |
| Extremadura | M54.5 | Low back pain | 0.76 |
| J11 | Influenza, virus not identified | 0.49 | |
| S93 | Dislocation, sprain and strain of joints and ligaments at ankle and foot level | 0.28 | |
| M54.2 | Cervicalgia | 0.23 | |
| M54.3 | Sciatica | 0.20 | |
| F41 | Other anxiety disorders | 0.18 | |
| M54.9 | Dorsalgia, unspecified | 0.17 | |
| M75 | Shoulder lesions | 0.14 | |
| Galicia | M54.5 | Low back pain | 1.19 |
| J11 | Influenza, virus not identified | 0.94 | |
| M54.2 | Cervicalgia | 0.47 | |
| F41 | Other anxiety disorders | 0.44 | |
| J20.9 | Acute bronchitis, unspecified | 0.42 | |
| M54.3 | Sciatica | 0.30 | |
| J03.9 | Acute tonsillitis, unspecified | 0.28 | |
| S93 | Dislocation, sprain and strain of joints and ligaments at ankle and foot level | 0.24 | |
| Community of Madrid | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 1.51 |
| M54.5 | Low back pain | 0.90 | |
| F41 | Other anxiety disorders | 0.76 | |
| J02.9 | Acute pharyngitis, unspecified | 0.67 | |
| J11 | Influenza, virus not identified | 0.53 | |
| M25 | Other joint disorders, not elsewhere classified | 0.48 | |
| M54.3 | Sciatica | 0.45 | |
| J06.9 | Acute upper respiratory infection, unspecified | 0.43 | |
| Region of Murcia | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 1.21 |
| J11 | Influenza, virus not identified | 1.16 | |
| M54.5 | Low back pain | 1.13 | |
| J02.9 | Acute pharyngitis, unspecified | 0.82 | |
| M54.3 | Sciatica | 0.69 | |
| R45 | Symptoms and signs involving emotional state | 0.62 | |
| M54.2 | Cervicalgia | 0.55 | |
| J06.9 | Acute upper respiratory infection, unspecified | 0.41 | |
| Chartered Community of Navarre | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 3.08 |
| J11 | Influenza, virus not identified | 2.52 | |
| M54.5 | Low back pain | 1.88 | |
| J06.9 | Acute upper respiratory infection, unspecified | 1.62 | |
| J00 | Acute nasopharyngitis (common cold) | 1.26 | |
| A08.5 | Ofter specified intestinal infections | 0.98 | |
| J20.9 | Acute bronchitis, unspecified | 0.95 | |
| F41.9 | Anxiety disorder, unspecified | 0.89 | |
| La Rioja | K52.9 | Non-infective gastroenteritis and colitis, unspecified | 2.20 |
| J00 | Acute nasopharyngitis (common cold) | 1.42 | |
| J11 | Influenza, virus not identified | 1.14 | |
| M54.5 | Low back pain | 1.10 | |
| M54.3 | Sciatica | 0.56 | |
| J06.9 | Acute upper respiratory infection, unspecified | 0.39 | |
| M25.5 | Pain in joint | 0.36 | |
| R45.0 | Nervousness | 0.35 | |
| Valencia | M54.5 | Low back pain | 1.04 |
| J11 | Influenza, virus not identified | 0.85 | |
| F41.9 | Anxiety disorder, unspecified | 0.56 | |
| K52.9 | Non-infective gastroenteritis and colitis, unspecified | 0.55 | |
| J00 | Acute nasopharyngitis (common cold) | 0.45 | |
| M54.2 | Cervicalgia | 0.39 | |
| M54.3 | Sciatica | 0.33 | |
| J20.9 | Acute bronchitis, unspecified | 0.32 | |
| Basque Country | M54.5 | Low back pain | 1.83 |
| M54.2 | Cervicalgia | 1.68 | |
| J00 | Acute nasopharyngitis (common cold) | 0.91 | |
| K52.9 | Non-infective gastroenteritis and colitis, unspecified | 0.75 | |
| J11 | Influenza, virus not identified | 0.63 | |
| F43.2 | Adjustment disorders | 0.56 | |
| F41.9 | Anxiety disorder, unspecified | 0.49 | |
| R10 | Abdominal and pelvic pain | 0.35 |
ICD-10, International Classification of Diseases, 10th Revision; SA, sickness absence.
SA spells by ISIC Rev-4
There is an outstanding number of SA spell in general public administration activities, hospital activities, retail sale in non-specialised stores with food, beverages or tobacco predominating and general cleaning of buildings (table 5).
Table 5.
Sickness absence situations by occupational activities (International Standard Industrial Classification of all Economic Activities, ISIC Rev-4)
| Autonomous community |
Code | Occupational activities | SA spells | SA/1000 affiliates |
| Andalusia | 8411 | General public administration activities | 61 457 | 30.84 |
| 8610 | Hospital activities | 40 544 | 20.30 | |
| 8121 | General cleaning of buildings | 23 802 | 18.89 | |
| 5610 | Restaurants and mobile food service activities | 23 377 | 28.5 | |
| 5630 | Beverage serving activities | 20 659 | 10.74 | |
| 4100 | Construction of buildings | 16 608 | 10.22 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 16 253 | 9 | |
| 5510 | Hotels and similar accommodation | 16 061 | 20.05 | |
| 4630 | Wholesale of food, beverage and tobacco | 15 010 | 9.72 | |
| 8220 | Activities of call centres | 14 652 | 69.07 | |
| Aragon | 8411 | General public administration activities | 9685 | 23.30 |
| 8610 | Hospital activities | 8022 | 16.61 | |
| 7820 | Temporary employment agency activities | 7550 | 73.50 | |
| 2930 | Manufacture of parts and accessories of motor vehicles | 5874 | 11.70 | |
| 8121 | General cleaning of buildings | 5464 | 21.78 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 3773 | 5.3 | |
| 5610 | Restaurants and mobile food service activities | 3669 | 28.5 | |
| 8220 | Activities of call centres | 3459 | 43 | |
| 4923 | Freight transport by road | 3214 | 15.57 | |
| 5630 | Beverage serving activities | 3073 | 10.95 | |
| Principality of Asturias | 8610 | Hospital activities | 6422 | 20.65 |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 5217 | 9.56 | |
| 8411 | General public administration activities | 4000 | 19.21 | |
| 5630 | Beverage serving activities | 2560 | 10.46 | |
| 2410 | Manufacture of basic iron and steel | 2330 | 12.08 | |
| 8121 | General cleaning of buildings | 2285 | 13.6 | |
| 5610 | Restaurants and mobile food service activities | 2047 | 22.45 | |
| 8730 | Residential care activities for the elderly and disabled | 1950 | 20.82 | |
| 8122 | Other building and industrial cleaning activities | 1651 | 18 | |
| 9700 | Activities of households as employers of domestic personnel | 1365 | 8.51 | |
| Balearic Islands | 5510 | Hotels and similar accommodation | 19 736 | 30.31 |
| 5610 | Restaurants and mobile food service activities | 9399 | 13.6 | |
| 8610 | Hospital activities | 8059 | 26.49 | |
| 8411 | General public administration activities | 6141 | 27.19 | |
| 4100 | Construction of buildings | 6129 | 13 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 5078 | 8.44 | |
| 5630 | Beverage serving activities | 4740 | 8.32 | |
| 8121 | General cleaning of buildings | 4125 | 16.70 | |
| 5520 | Short-term accommodation activities | 3034 | 12.56 | |
| 4751 | Retail sale of textiles in specialised stores | 2408 | 21.6 | |
| Canary Islands | 5510 | Hotels and similar accommodation | 26 147 | 43.13 |
| 8610 | Hospital activities | 16 865 | 30.7 | |
| 8411 | General public administration activities | 15 899 | 31.59 | |
| 5610 | Restaurants and mobile food service activities | 11 628 | 18.32 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 10 495 | 7.9 | |
| 5520 | Short-term accommodation activities | 7221 | 32.30 | |
| 8121 | General cleaning of buildings | 7000 | 18.7 | |
| 5630 | Beverage serving activities | 5507 | 8.36 | |
| 4100 | Construction of buildings | 5414 | 11.70 | |
| 8521 | General secondary education | 5340 | 12.13 | |
| Cantabria | 8411 | General public administration activities | 3851 | 28.5 |
| 7820 | Temporary employment agency activities | 3612 | 76.53 | |
| 8610 | Hospital activities | 3492 | 20.09 | |
| 8121 | General cleaning of buildings | 1828 | 17.11 | |
| 5610 | Restaurants and mobile food service activities | 1616 | 22.5 | |
| 5630 | Beverage serving activities | 1383 | 10.97 | |
| 8220 | Activities of call centres | 1170 | 60 | |
| 8521 | General secondary education | 1170 | 8.38 | |
| 4791 | Retail sale via mail order houses or via Internet | 1023 | 16.8 | |
| 8620 | Medical and dental practice activities | 998 | 32 | |
| Castile and Leon | 8411 | General public administration activities | 9940 | 16.89 |
| 8610 | Hospital activities | 9741 | 12.04 | |
| 8220 | Activities of call centres | 8920 | 85.14 | |
| 8121 | General cleaning of buildings | 7489 | 17.87 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 5953 | 7.94 | |
| 8790 | Other residential care activities | 5089 | 21.95 | |
| 5630 | Beverage serving activities | 5023 | 14.59 | |
| 7820 | Temporary employment agency activities | 4676 | 45.75 | |
| 5610 | Restaurants and mobile food service activities | 4493 | 24.90 | |
| 2910 | Manufacture of motor vehicles | 4409 | 10.35 | |
| Castile La Mancha | 8411 | General public administration activities | 15 003 | 22.17 |
| 8610 | Hospital activities | 7820 | 14.89 | |
| 8121 | General cleaning of buildings | 5363 | 19.98 | |
| 7820 | Temporary employment agency activities | 5272 | 56.70 | |
| 5210 | Warehousing and storage | 5251 | 60 | |
| 4100 | Construction of buildings | 4479 | 8.94 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 4267 | 5.06 | |
| 5610 | Restaurants and mobile food service activities | 4092 | 32.54 | |
| 4923 | Freight transport by road | 3846 | 14.08 | |
| 5630 | Beverage serving activities | 3526 | 10.62 | |
| Catalonia | 8610 | Hospital activities | 75 958 | 32.68 |
| 8411 | General public administration activities | 70 569 | 32.11 | |
| 5610 | Restaurants and mobile food service activities | 45 084 | 47 | |
| 8121 | General cleaning of buildings | 44 117 | 22.8 | |
| 7820 | Temporary employment agency activities | 43 109 | 73.56 | |
| 8220 | Activities of call centres | 37 877 | 74.91 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 30 528 | 12.95 | |
| 4751 | Retail sale of textiles in specialised stores | 24 417 | 10.36 | |
| 8812 | Social work activities without accommodation for the elderly and disabled | 20 007 | 43.56 | |
| 8423 | Public order and safety activities | 19 807 | 65 | |
| Extremadura | 8411 | General public administration activities | 10 813 | 23.68 |
| 8610 | Hospital activities | 5921 | 17.95 | |
| 8121 | General cleaning of buildings | 2007 | 19.56 | |
| 8812 | Social work activities without accommodation for the elderly and disabled | 1643 | 18 | |
| 4100 | Construction of buildings | 1610 | 7.48 | |
| 5630 | Beverage serving activities | 1599 | 10.55 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 1136 | 3.98 | |
| 5610 | Restaurants and mobile food service activities | 1044 | 13.64 | |
| 4923 | Freight transport by road | 914 | 12.89 | |
| 0150 | Mixed farming | 902 | 8.79 | |
| Galicia | 8610 | Hospital activities | 12 552 | 16.6 |
| 8411 | General public administration activities | 12 137 | 19.12 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 7498 | 6.4 | |
| 5630 | Beverage serving activities | 6532 | 12 | |
| 8121 | General cleaning of buildings | 5775 | ||
| 7820 | Temporary employment agency activities | 5270 | 40.61 | |
| 9700 | Activities of households as employers of domestic personnel | 4830 | 11.45 | |
| 5610 | Restaurants and mobile food service activities | 4664 | 17.6 | |
| 8220 | Activities of call centres | 4558 | 47.19 | |
| 4100 | Construction of buildings | 3622 | 5.27 | |
| Community of Madrid | 8610 | Hospital activities | 44 482 | 17.65 |
| 8121 | General cleaning of buildings | 42 703 | 20.63 | |
| 5610 | Restaurants and mobile food service activities | 36 939 | 28.54 | |
| 4711 | General public administration activities | 35 475 | 21.94 | |
| 8220 | Activities of call centres | 29 212 | 67.3 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 28 014 | 7.57 | |
| 9700 | Activities of households as employers of domestic personnel | 21 385 | 20.93 | |
| 8299 | Other business support service activities n.e.c | 20 351 | 13 | |
| 5630 | Beverage serving activities | 17 608 | 12.05 | |
| 4751 | Retail sale of textiles in specialised stores | 15 735 | 15.31 | |
| Region of Murcia | 8620 | Medical and dental practice activities | 11 008 | 34.8 |
| 0113 | Growing of vegetables and melons, roots and tubers | 7233 | 28.29 | |
| 7820 | Temporary employment agency activities | 6037 | 23.35 | |
| 4711 | General public administration activities | 6003 | 24.41 | |
| 8121 | General cleaning of buildings | 4915 | 25.01 | |
| 5610 | Restaurants and mobile food service activities | 3672 | 34.02 | |
| 5630 | Beverage serving activities | 3635 | 21.63 | |
| 4630 | Wholesale of food, beverage and tobacco | 3514 | 13.62 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 3228 | 8.96 | |
| 4923 | Freight transport by road | 2914 | 14.28 | |
|
Chartered Community of Navarre |
8610 | Hospital activities | 14 408 | 46.16 |
| 8411 | General public administration activities | 7408 | 57.01 | |
| 2930 | Manufacture of parts and accessories of motor vehicles | 5782 | 18.2 | |
| 7820 | Temporary employment agency activities | 5558 | 94.19 | |
| 8521 | General secondary education | 3909 | 19.86 | |
| 8121 | General cleaning of buildings | 3520 | 31.17 | |
| 1030 | Processing and preserving of fruit and vegetables | 3256 | 38.37 | |
| 2910 | Manufacture of motor vehicles | 3195 | 17.07 | |
| 8812 | Social work activities without accommodation for the elderly and disabled | 3151 | 76.35 | |
| 9700 | Activities of households as employers of domestic personnel | 2382 | 23.71 | |
| La Rioja | 8610 | Hospital activities | 1698 | 18.25 |
| 8611 | General public administration activities | 1612 | 22.76 | |
| 1520 | Manufacture of footwear | 1463 | 38.2 | |
| 8121 | General cleaning of buildings | 1290 | 29.05 | |
| 1030 | Processing and preserving of fruit and vegetables | 1217 | 27.4 | |
| 7820 | Temporary employment agency activities | 1060 | 71.12 | |
| 2930 | Manufacture of parts and accessories of motor vehicles | 1006 | 12.1 | |
| 5630 | Beverage serving activities | 973 | 14.3 | |
| 1102 | Manufacture of wines | 962 | 13.09 | |
| 0113 | Growing of vegetables and melons, roots and tubers | 907 | 21.5 | |
| Valencia | 8610 | Hospital activities | 24 063 | 21.57 |
| 8611 | General public administration activities | 23 311 | 24.51 | |
| 5610 | Restaurants and mobile food service activities | 16 234 | 20.93 | |
| 8121 | General cleaning of buildings | 12.758 | 16.04 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 11 239 | 6.14 | |
| 4630 | Wholesale of food, beverage and tobacco | 7300 | 8.81 | |
| 5630 | Beverage serving activities | 8732 | 6.49 | |
| 4923 | Freight transport by road | 7300 | 11.49 | |
| 7820 | Temporary employment agency activities | 7126 | 29.24 | |
| 4100 | Construction of buildings | 6663 | 6.21 | |
| Basque Country | 8610 | Hospital activities | 22 704 | 30.48 |
| 8611 | General public administration activities | 15 565 | 27.16 | |
| 8121 | General cleaning of buildings | 13 043 | 29.20 | |
| 8521 | General secondary education | 12 519 | 14.51 | |
| 8812 | Social work activities without accommodation for the elderly and disabled | 8760 | 14.75 | |
| 5610 | Restaurants and mobile food service activities | 8419 | 29.01 | |
| 4711 | Retail sale in non-specialised stores with food, beverages or tobacco predominating | 6625 | 6.6 | |
| 9700 | Activities of households as employers of domestic personnel | 6284 | 18.55 | |
| 2591 | Forging, pressing, stamping and roll-forming of metal; powder metallurgy | 6086 | 10.29 | |
| 5630 | Beverage serving activities | 5842 | 18.02 |
SA, sickness absence.
However, when these cases are analysed by the number of affiliates in each occupational activities, those occupations in which the most SA spells is found are activities of call centres, temporary employment agency activities and general public administration activities.
Discussion
The obtained results confirm many of the findings described by other authors at both the national17 and international levels.18
The prevalence and incidence are much higher in non-work-related SA than in work-related SA, which is logical, since work-related SA only included the accidents occurred in the workplace, as well as the professional diseases described in the Royal Decree 1299/2006 of 10th November, and not all diseases, accidents and injuries that any worker can suffer from. Conversely, in the case of non-work-related SA all illness and accidents are included.
When the SA prevalence in each region is analysed, it is observed that there are few regions, such as Aragon and the Community of Madrid, below the national average. By breaking it down into non-work-related SA, the regions that are below the average were Andalusia, Aragon, the Balearic Island, Community of Madrid, La Rioja and Valencian Community, while in work-related SA, Aragon, Catalonia, the Basque Country, the Canary Islands and Community of Madrid stand out below the average. It is difficult to know the reasons for these differences in the prevalence SA. To analyse the possible causes of these differences, it would be necessary to carry out other sorts of studies.
There are also important differences concerning incidence, with these differences being very marked in some regions. Only Castile and Leon does not reach the national average. In the case of non-work-related SA, Andalusia, Castile and Leon, Extremadura and Valencian Community are below the national average. In work-related SA, values are very approximate in all regions. The highest value is in the Balearic Islands.
There is a significant difference in the incidence of SA between the employed and self-employed which was much higher in the former. This is in line with the results obtained in other studies conducted in Spain4 and at an international level.7 19 20 The self-employed are only charging for the work they have done. On the other hand, if they are in SA’s position, the amount they receive is lower, because it depends on their contributions to the social security system.
The average duration is shorter in all regions in the case of work-related SA because these SA are managed directly by associated insurance companies, whose network of doctors and hospital beds are exclusively for workers who had suffered occupational accidents or professional illness. In the case of non-work-related SA, healthcare is provided by the Public Health System, where other patients are also treated (children, elderly, non-working patients, and so on) and, therefore, waiting lists were longer and treatments for these patients could be delayed further. Besides, the longest duration is for oncological diseases and mental disorders, the origin of which is usually unrelated to work. This finding is in line with that of other studies at the national4 and European19 level. Non-work-related SA showed a longer duration to work-related SA which has remained like this for years.14 The region that showed the shortest duration as a whole is Navarre, where the health expenditure per inhabitant is also the highest in Spain. Healthcare expenditure is also higher in the Basque Country, however, the duration of the it is one of the longest in many diagnostic chapters.
The most noteworthy fact is that the number of days on SA for self-employed workers is twice as much as for employees in all of Spain’s regions. In our experience, this can be caused by the fact that self-employed workers do not usually start a process of short-term SA, because cash benefits for SA are paid 30 days after the start of SA and they do not receive cash benefits in short-term SA
The incidence, prevalence and average duration increase with age. This occurrs in all age ranges except for very young workers (men and women) and those over 65 years old. In young people it can be explained by the fact that they often have low-skilled jobs (they have not yet finished their education). They are often temporary and unstable jobs, and many young people work and study at the same time. This causes a double workload that could contribute to worsening their health. As it can be seen, they are short-term SA, which could indicate a low severity of the pathologies that produce them. In the over-65s the prevalence is very low in all regions. One possible explanation is that the retirement age in Spain is around 65 and the worker who decides to continue working instead of retiring is in good health. However, the duration of these SA is very long, because at this age there is a greater prevalence of serious pathologies (neoplasms, ictus, and so on).
The differences observed in the number of employees regarding sex are in line with the patterns obtained in other studies, with higher incidence19 and longer duration21 in women. There is a sex breach in some European countries (Spain, Ireland, France, Belgium and UK) compared with others (Netherlands, Portugal and Italy).21 22 The incidence increases with age, which is in agreement with most studies at the national4 23 and international7 18 21–24 level, with higher intensity according to the number of affiliates per sex and age range (table 2). Among the multiple explanations for this fact, it is worth highlighting the following: the double work women usually carry out, that is, paid work and domestic work, with greater responsibilities for the family (traditional gender role),22 24 the different behaviour of women toward disease,22 their greater morbidity related to maternity25 and more fragile health,26 as well as their lower commitment to work.22 Other authors highlight the occupational differences, which could explain more than half of the gender differences,24 as well as the stress level.24 However, this gender breach is not constant in the long-term in all the European countries;21 22 in fact, some studies question its existence based on the occupational level27 and the stress level.28
The longest duration by diagnostic chapter is oncological diseases, cardiovascular diseases and mental disorders, which is in line with other studies.29–31 Moreover, this fact poses a serious problem of public health, given the accelerated increase of chronic diseases in all the countries around Spain,32 with the consequent increase in the incidence and duration of SA and the cost that it implies.4 29
The diagnosis that generated the largest number of SA cases, after the influenza, is lower back pain. This finding is in line with numerous studies, being, nationally, the main diagnosis of sick leave due to its high incidence and recurrence rate,33 as well as the duration23 34 35 and economic costs of such SA.35 This is due to the great prevalence of such pathology, regardless of whether or not it generates SA cases,33 36 among other factors.
The Public Administration is in the first, second and third positions in the described ranking in almost all the regions. This can be explained by the difference between workers of the public sector, who represent a greater number of SA cases than employees in the private sector, as in other countries.19 37 38 However, in previous studies carried out in Spain, the Public Administration did not represent or occupied such an important place in SA spells, being greatly surpassed by the industrial and construction sectors.16 39
When the SA spells are analysed by the number of affiliated workers in each occupational activities, a higher number of them is found in workers in call centres and temporary employment agencies. These activities have a high level of job instability, with a high worker turnover and very short-term contracts.40 This could explain the high rate of absence in them.
One of the occupational activities with the highest number of SA spells is retail sale in non-specialised stores with food, beverages or tobacco predominating, but when it is analysed by the number of affiliates, this number of SA spells is one of the lowest of all occupational activitiess. One possible explanation is that many of these workers are self-employed and, as mentioned before, in these workers the SA incidence is very low.
Conclusion
This study shows the important characteristics of SA in Spain. The most important differences are found in SA incidence and average duration between the different regions and non-work-related and work-related SA spells. There are also important differences in the number of SA spells between different occupational activities.
The regions that show the most difference SA are the Chartered Community of Navarre and the Community of Madrid. It would be interesting to carry out further studies that analyse the main factors that influence SA in Spain.
Supplementary Material
Acknowledgments
We would like to thank the National Institute of Social Security for helping with the databases.
Footnotes
Contributors: MLAJ, MJAB, NMM, MTLM and RMV conceived the original proposal and drafted the original manuscript. MLAJ, MJAB, NMM and RMV contributed to the development and refinement and statistical analysis of the protocol. All authors critically appraised the drafted manuscript and made important intellectual contributions to the writing. All authors have read and approved the final submitted manuscript.
Funding: The University of Malaga through a predoctoral grant supports MLAJ, 900004852 a PhD student at the University.
Competing interests: None declared.
Patient consent for publication: Not required.
Ethics approval: This project was approved by Andalusia Ethics Committee (ID900004852).
Provenance and peer review: Not commissioned; externally peer reviewed.
Data availability statement: Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article. Data are available in a public, open access repository: http://www.seg-social.es/wps/portal/wss/internet/EstadisticasPresupuestosEstudios/
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