Illness Absence Patterns Among Employees in a Petrochemical Facility: Impact of Selected Health Risk Factors

A Literature Review of Productivity Loss Associated with Hypertension in the United States

A literature review of peer-reviewed articles published 2000-2019 was conducted to determine the types and extent of hypertension-associated productivity loss among adults in the United States. All monetary outcomes were standardized to 2019 $ by using the Employment Cost Index. Twenty-seven articles met the inclusion criteria. Nearly half of the articles (12 articles) presented monetary outcomes of productivity loss. Absenteeism (14 articles) and presenteeism (8 articles) were most frequently assessed. Annual absenteeism was estimated to cost more than $11 billion, nationally controlling for sociodemographic characteristics. The annual additional costs per person were estimated at $63 for short-term disability, $72-$330 for absenteeism, and $53-$156 for presenteeism, controlling for participant characteristics; and may be as high as $2362 for absenteeism and presenteeism when considered in combination. The annual additional time loss per person was estimated as 1.3 days for absenteeism, controlling for common hypertension comorbidities, including stroke and diabetes; and 15.6 days for work and home productivity loss combined, controlling for sociodemographic characteristics. The loss from absenteeism alone might be more than 20% of the total medical expenditure of hypertension. Although the differences in estimation methods and study populations make it challenging to synthesize the costs across the studies, this review provides detailed information on the various types of productivity loss. In addition, the ways in which methods could be standardized for future research are discussed. Accounting for the costs from productivity loss can help public health officials, health insurers, employers, and researchers better understand the economic burden of hypertension.

One-year weight change and long-term sickness absence in professional firefighters

BACKGROUND

Little is known about the association between weight change (particularly moderate weight loss, 5-10% in initial weight) and long-term sickness absence (LSA) in working populations.

METHODS

Three hundred and forty professional firefighters reported their current and past (1 year ago) weights in a cross-sectional survey, along with their LSA experience due to a severe accident, injury, or illness during the previous 12 months.

RESULTS

The prevalence of LSA was 14.7%. In the non-smoking male firefighters, the prevalence of LSA was 3.4% in those with moderate weight loss over the past year; 13.3% in those who maintained their weight; and 21.7% in those who gained their weight moderately: gamma coefficient, 0.44 (95%CI: 0.05, 0.66). The linear association remained significant after further controlling for age and alcohol consumption. And it was similar across the adiposity strata (normal weight, overweight, and obesity) of the firefighters 1 year ago.

CONCLUSIONS

One-year weight loss was associated with decreased risk of LSA in professional firefighters.

Association of Amplitude and Stability of Circadian Rhythm, Sleep Quality, and Occupational Stress with Sickness Absence among a Gas Company Employees-A Cross Sectional Study from Iran

Background

The present study was carried out to assess the relationship between sickness absence and occupational stress, sleep quality, and amplitude and stability of circadian rhythm as well as to determine contributing factors of sickness absence.

Methods

This cross sectional study was conducted on 400 randomly selected employees of an Iranian gas company. The data were collected using Pittsburgh sleep quality index, Karolinska sleepiness scale, circadian type inventory, and Osipow occupational stress questionnaires.

Results

The mean age and job tenure of the participants were 33.18 ± 5.64 years and 6.06 ± 4.99 years, respectively. Also, the participants had been absent from work on average 2.16 days a year. According to the results, 209 participants had no absences, 129 participants had short-term absences, and 62 participants had long-term absences. The results showed a significant relationship between short-term absenteeism and amplitude of circadian rhythm [odds ratio (OR) = 6.13], sleep quality (OR = 14.46), sleepiness (OR = 2.08), role boundary (OR = 6.45), and responsibility (OR = 5.23). Long-term absenteeism was also significantly associated with amplitude of circadian rhythm (OR = 2.42), sleep quality (OR = 21.56), sleepiness (OR = 6.44), role overload (OR = 4.84), role boundary (OR = 4.27), and responsibility (OR = 3.72).

Conclusion

The results revealed that poor sleep quality, amplitude of circadian rhythm, and occupational stress were the contributing factors for sickness absence in the study population.

The Role of Vitality in the Relationship Between a Healthy Lifestyle and Societal Costs of Health Care and Lost Productivity: A Mediation Analysis

PURPOSE

To examine the mediating effect of vitality in the relationship between healthy lifestyle characteristics and health-care and productivity-related costs.

DESIGN

Observational prospective cohort study with 2 measurements. Online questionnaires were filled out in 2013 (T0) and 2014 (T1).

SETTING

A random sample of a Dutch online interview panel was obtained.

SUBJECTS

Data of 4231 Dutch adults who had complete data at T0 and T1 were used in the present study. Participants were representative for the Dutch adult population in terms of age, gender, and having chronic disease(s).

MEASURES

Healthy Lifestyle Index (HLI), vitality, and health-care and productivity-related costs. The HLI consisted of the sum of 6 healthy lifestyle characteristics, including a healthy BMI (yes/no), meeting physical activity, fruit, vegetable, and alcohol consumption guidelines (yes/no), and smoking status (yes: non or former smoker/no: current smoker). Health-care and productivity-related costs were measured using a utilization questionnaire.

ANALYSIS

Linear regression analysis.

RESULTS

The HLI was related to vitality. In addition, vitality was related to health-care costs and productivity-related costs. Furthermore, vitality was found to transmit 28.4% of the effect of HLI on health-care costs and 39.4% of the effect of HLI on productivity-related costs.

CONCLUSION

Lifestyle was related to vitality and vitality to health-care and productivity-related costs. Vitality mediated the relationship between lifestyle and health-care and productivity-related costs. Therefore, we recommend to sustain and improve both vitality and lifestyle.

Simulating the impact of changing trends in smoking and obesity on productivity of an industrial population: an observational study

OBJECTIVE

To estimate the impact of trends in smoking and obesity prevalence on productivity loss among petrochemical employees from 1980 to 2009.

METHODS

Smoking and obesity informations were collected during company physical examinations. Productivity loss was calculated as differential workdays lost between smokers and non-smokers, and obese and normal-weight employees.

RESULTS

During 1980-2009, smoking prevalence decreased from 32% to 17%, while obesity prevalence increased from 14% to 42%. In 1982, lost productivity from obesity was an estimated 43 days/100 employees, and for smoking, 65 days/100 employees, but by 1987, workdays lost due to obesity exceeded that attributable to smoking. In 2007, workdays lost from obesity were 3.7 times higher than for smoking.

CONCLUSIONS

Owing to the increasing trend in obesity, the productivity impact on employers from obesity will continue to rise without effective measures supporting employee efforts to achieve healthy weight through sustainable lifestyle changes.

The association between modifiable well-being risks and productivity: a longitudinal study in pooled employer sample

OBJECTIVE

To examine the longitudinal relationship between modifiable well-being risks and productivity.

METHODS

A total of 19,121 employees from five employers participated in baseline and follow-up well-being assessment surveys. Multivariate regressions assessed whether changes in absenteeism, presenteeism, and job performance were associated with changes in 19 modifiable well-being risks.

RESULTS

Over time, a 5% reduction in total count of well-being risks was significantly associated with 0.74% decrease in absenteeism, 2.38% decrease in presenteeism, and 0.24% increase in performance. High blood pressure, recurring pain, unhealthy diet, inadequate exercise, poor emotional health, poor supervisor relationship, not utilizing strengths doing job, and organization unsupportive of well-being had greater independent contributions in explaining productivity impairment.

CONCLUSIONS

The often-ignored well-being risks such as work-related and financial health risks provided incremental explanation of longitudinal productivity variations beyond traditional measures of health-related risks.

[Worksite health promotion and occupational physicians: interventional effects of exercises]

Results of annual health checkups at workplaces revealed a steady increase in the incidence of cardiovascular risk factors such as dyslipidemia and hypertension in Japan. With the aging of the workforce, the incidence is expected to increase further. These risk factors are modifiable through a lifestyle modification program including mild exercise and nutritional guidance. In 1988, the Japanese government revised the Industrial Safety and Health Law to promote health in the workplace and implemented the Total Health Promotion Plan (THP). However, only 5.0% of workplaces were implementing THP programs according to a survey conducted in 2007. Therefore, we have recommended some measures for worksite health promotion, such as collaboration between community health and occupational health for implementing health promotion activities especially in small and medium scale enterprises, environmental improvement to promote occupational health, and an approach to increase physical activity that includes walking to work and using the stairs. Worksite health promotion should be considered an important company initiative in terms of work-related outcomes such as job satisfaction, work ability, and absenteeism in addition to cardiovascular risk factors.

The effects of single long and accumulated short bouts of exercise on cardiovascular risks in male Japanese workers: a randomized controlled study

The aim of this study was to determine whether accumulated short bouts of exercise can achieve the same cardiovascular benefits as a single long bout of exercise in sedentary male Japanese workers and to compare the programs' relative effects on oxidative stress. Twenty-three sedentary male workers were randomly assigned into 2 different exercise programs: a Long-bout group, which performed a single period of continuous exercise (Long-bout group: 30 min × 1) 3 d per week, and a Short-bouts group, which performed 3 short bouts of exercise (Short-bouts group: 10 min × 3) 3 d per week. Cardiovascular risk factors, including the plasma thiobarbituric acid-reactive substances (TBARS) level, were examined at baseline and after both 10 and 20 wk. In the Long-bout group, waist circumference and maximum oxygen uptake (VO2max) significantly improved after 20 wk. The Short-bouts group demonstrated significant increases in VO2max after 10 weeks and in HDL-C after 20 wk. Plasma TBARS significantly decreased after 20 weeks in the Long-bout group and tended to decrease (but not significantly) in the Short-bouts group. These results indicate that accumulated short bouts of exercise are an effective option, especially for busy workers, for incorporating exercise into one's lifestyle.

Promoting health and wellness in the workplace: a unique opportunity to establish primary and extended secondary cardiovascular risk reduction programs

Given the burden of cardiovascular disease (CVD), increasing the prevalence of healthy lifestyle choices is a global imperative. Currently, cardiac rehabilitation programs are a primary way that modifiable risk factors are addressed in the secondary prevention setting after a cardiovascular (CV) event/diagnosis. Even so, there is wide consensus that primary prevention of CVD is an effective and worthwhile pursuit. Moreover, continual engagement with individuals who have already been diagnosed as having CVD would be beneficial. Implementing health and wellness programs in the workplace allows for the opportunity to continually engage a group of individuals with the intent of effecting a positive and sustainable change in lifestyle choices. Current evidence indicates that health and wellness programs in the workplace provide numerous benefits with respect to altering CV risk factor profiles in apparently healthy individuals and in those at high risk for or already diagnosed as having CVD. This review presents the current body of evidence demonstrating the efficacy of worksite health and wellness programs and discusses key considerations for the development and implementation of such programs, whose primary intent is to reduce the incidence and prevalence of CVD and to prevent subsequent CV events. Supporting evidence for this review was obtained from PubMed, with no date limitations, using the following search terms: worksite health and wellness, employee health and wellness, employee health risk assessments, and return on investment. The choice of references to include in this review was based on study quality and relevance.

Smoking and absence from work: systematic review and meta-analysis of occupational studies

AIMS

This study aimed to assess the association between smoking and absenteeism in working adults.

METHODS

A systematic review and meta-analysis was performed by electronic database searches in MEDLINE, EMBASE, CAB Abstracts, PubMed, Science Direct and National Health Service Economic Evaluation Database (February 2012). Longitudinal, prospective cohorts or retrospective cohorts were included in the review. Summary effect estimates were calculated using random-effects meta-analysis. Heterogeneity was assessed by I(2) and publication bias was investigated.

RESULTS

A total of 29 longitudinal or cohort studies were included. Compared with non-smokers, current smokers had a 33% increase in risk of absenteeism [95% confidence interval (CI): 1.25-1.41; I(2)  = 62.7%; 17 studies]. Current smokers were absent for an average of 2.74 more days per year compared with non-smokers (95% CI: 1.54-3.95; I(2)  = 89.6%; 13 studies). Compared with never smokers, ex-smokers had a 14% increase in risk of absenteeism (95% CI: 1.08-1.21; I(2)  = 62.4%; eight studies); however, no increase in duration of absence could be detected. Current smokers also had a 19% increase in risk of absenteeism compared with ex-smokers (95% CI: 1.09-1.32, P < 0.01, eight studies). There was no evidence of publication bias. The total cost of absenteeism due to smoking in the United Kingdom was estimated to be £1.4 billion in 2011.

CONCLUSIONS

Quitting smoking appears to reduce absenteeism and result in substantial cost-savings for employers.

Factors Associated with Incidental Sickness Absence among Employees in One Health Care System

Purpose.

Assess the association of taking incidental sickness absence with health risks and health status.

Design.

Observational.

Setting.

One Midwest health care system.

Subjects.

Individuals who were employed for 2 years (2006–2007) and had completed at least one health risk appraisal (HRA) in 2007 (N = 3790).

Measures.

Outcomes were any incidental sickness absence and absence duration in 2007 measured by an absence tracking system. Health risks and health status were estimated by HRAs. Program participation was captured using 7-year HRA data and 5-year wellness data.

Analysis.

Multivariate, binary logistic regression for the probability of taking any absence day among the overall population as well as four demographic subgroups; proportional odds model for the probability of taking more absence days.

Results.

Different patterns were observed in association with taking incidental sickness absence among age and gender subgroups. Among the overall population, three health risks (smoking overweight, and use of medication for relaxation) were positively associated with taking absence (at least p <. 05 for all three health risks). Participation in a wellness program for more years was also associated with a less likelihood of taking absence (odds ratio, .72; p = .002). Results from the proportional odds model were consistent with results from the binary logistic regression.

Conclusion.

Sickness absence is an important productivity concern of employers. Employers may implement early interventions to focus on preventable causes. Special interventions may target absence-causing risks such as smoking behavior and excess body weight. Study limitation includes a lack of measures for psychosocial work environment.

Use of a normal impairment factor in quantifying avoidable productivity loss because of poor health

OBJECTIVE

Growing evidence demonstrates a relationship between excess health risk and preventable productivity loss. There is a need to quantify how much lost productivity is avoidable through employer-sponsored health management interventions. This study introduced the Normal Impairment Factor (NIF) to recognize the amount of productivity loss that cannot be mitigated through health management interventions.

METHODS

A health assessment questionnaire was administered to 772,750 employees, representing 106 employers within five industry sectors. Researchers used multivariate regression procedures to examine the association between preventable health risks and self-reported productivity loss.

RESULTS

Back pain, mental well being, and stress risk were the strongest predictors of on-the-job productivity loss. A strong association was also detected between the number of health risks and productivity loss ranging from 3.4% for those at lowest risk (the NIF group) to 24.0% loss for those at risk for eight risks.

CONCLUSIONS

This study demonstrated the utility of the NIF in estimating the level of productivity loss that cannot be regained through health management interventions.

Obesity status and sick leave: a systematic review

This review identified 36 studies on the relation between obesity status and sick leave. Pooling of effect estimates was not possible due to great heterogeneity between studies regarding definition of sick leave (short-term/long-term), measure of obesity (body mass index/waist circumference/percentage body fat), definition of obesity status (World Health Organization standards/other), study population (sex/age/occupation/country) and exposure and outcome ascertainment (self-reported/objectively assessed). Nevertheless, a clear trend towards greater sick leave among obese compared with normal weight workers could be discerned, especially for spells of longer duration. In studies from the USA, which consistently reported about five times lower number of sick leave days per person-year than European, obese workers had about 1-3 extra days of absence per person-year compared with their normal weight counterparts. In European studies, the corresponding difference was about 10 d. For overweight workers the data were conflicting, indicating either increased or neutral level of sick leave compared with normal weight. Regarding underweight, the studies were very few and concerns regarding direction of causality were greater. Finally, in all four interventional studies identified substantial weight loss in obese subjects resulted in reduced sick leave, at least temporarily. In conclusion, increasing obesity in children and adults is likely to negatively affect future productivity as obesity increases the risk of sick leave, disability pension and death.

The association of diabetes with job absenteeism costs among obese and morbidly obese workers

OBJECTIVE

To determine the extent to which absenteeism costs associated with obesity and morbid obesity are traceable to diabetes, and whether obesity and morbid obesity remain predictors of absenteeism costs after controlling for diabetes.

METHODS

Data from the Medical Expenditure Panel Survey for 2000-2004 are examined. Outcomes are probability of missing work in the previous year and number of workdays missed. Predictors include diabetes, obesity and morbid obesity, age, education, occupation category, and race. Models are estimated by gender.

RESULTS

Probability of missing work in the past year, number of days missed, and absenteeism costs rise significantly with diabetes among the obese and morbidly obese, with costs higher for the morbidly obese, after controlling for diabetes.

CONCLUSIONS

Diabetes is strongly predictive of absenteeism among obese and morbidly obese workers. Employer efforts to reduce absenteeism should include consideration of anti-obesity interventions and diabetes prevention.

Indirect costs of obesity: a review of the current literature

This study reviews the recent literature on the relationship between obesity and indirect (non-medical) costs. Medline and Web of Science searches were conducted to identify published studies from 1992 to present that report indirect costs by obesity status; 31 studies were included. The indirect costs were grouped into six categories: costs associated with absenteeism, disability, premature mortality, presenteeism, workers' compensation, and total indirect costs. Compared with non-obese workers, obese workers miss more workdays due to illness, injury, or disability. Costs of premature mortality vary substantially across countries. The results for presenteeism and workers' compensation were mixed. More research is needed to determine obesity's causal role in increasing indirect costs, especially for workers' compensation and presenteeism. Cohort and longitudinal study designs should be a priority.

The impact of body mass index on short-term disability in the workplace

OBJECTIVE

The objective of this study was to assess the association between body mass index and short-term disability in a working "white collar" population.

METHODS

The authors collected cross-sectional data from 19,061 health risk appraisals completed by employees of a large financial services corporation from 2000-2002. The self-reported information for demographics and job satisfaction was combined with personnel and detailed information from short-term disability events (STD) taken during the same time period.

RESULTS

After adjusting for multiple covariates, body mass index is an independent predictor for STD events. Body mass index categories of overweight and obese have odds ratios of 1.26 and 1.76 compared with normal weight (P < 0.0001).

CONCLUSIONS

The improvement of employee health and wellness should be pursued by the employer in an effort to promote healthier weight among their workers. This in turn should reduce STD events that result in the loss of worker productivity and a major cost to companies.