Body mass index and risk of sick leave: A systematic review and meta-analysis

Sex-Specific Associations Between Lifestyle Factors and Sick Leave in the Serbian Working Population: Findings from the National Health Survey

Background/Objectives: Sick leave is influenced by various modifiable lifestyle factors and sex differences. This study investigates the associations between body mass index, fruit and vegetable consumption, physical activity, smoking, and alcohol consumption and sick leave among Serbia's working population, with emphasis on sex differences. Methods: Data from the 2019 National Health Survey of Serbia were analyzed, involving a sample of 4652 individuals. Chi-square tests and logistic regression models assessed the relationships between lifestyle factors and sick leave. Results: Among the participants, 15.8% reported sick leave in the past 12 months, with higher rates among women in both short-term (13.9% vs. 10.6%) and long-term (3.4% vs. 2.2%) sick leave. This study identifies obesity (OR = 2.6), poor dietary habits (fruit OR = 2.1; vegetables OR = 2.8), smoking (OR = 1.9), and risky alcohol consumption (OR = 4.1) as key predictors of sick leave in men, while smoking (OR = 1.8) and risky alcohol consumption (OR = 3.1) are major predictors in women. The inconsistent association between diet, physical activity, and sick leave may be attributed to differences in reporting accuracy, differing definitions of healthy intake, or the influence of unmeasured lifestyle factors. Conclusions: Smoking and risky alcohol consumption increase the odds of sick leave for both sexes. Interventions targeting smoking cessation and mitigating risky alcohol consumption could significantly decrease sick leave rates. While fruit and vegetable consumption, along with physical activity, showed inconsistent effects in both sexes, further studies are warranted to elucidate their roles.

Assessing the Fiscal Burden of Overweight and Obesity in Japan through Application of a Public Economic Framework

Introduction: Obesity continues to represent a significant public health concern, with a broad impact from both a health and economic perspective. Objective: This analysis assesses the fiscal consequences of overweight and obesity (OAO) in Japan by capturing obesity-attributable lost tax revenue and increased government transfers using a government perspective. Methods: The fiscal burden of OAO was estimated using an age-specific prevalence model, which tracked the Japanese population across different body mass index (BMI) categories. The model was populated with fiscal data for Japan, including employment activity and government spending, to calculate tax revenue and transfer costs. A targeted literature review was conducted to identify data estimating the impact of OAO on employment, income, sick leave, retirement, and mortality. These modifiers were applied to Japanese epidemiological and fiscal projections to calculate government tax revenue and spending. The incremental impact of reducing OAO in the general population was subsequently calculated. Results were estimated based on the 2023 Japanese working-age population aged 18 to 70 years. Results: The total fiscal burden of OAO in Japan, defined as BMI of at least 25, is estimated at US 13.41 b i l l i o n ( ¥ 1925 b i l l i o n ) , r e p r e s e n t i n g 0.4 6.3 billion (¥901 billion) and 1.2 b i l l i o n ( ¥ 179 b i l l i o n ) i n d i r e c t a n d i n d i r e c t t a x r e v e n u e , r e s p e c t i v e l y , d u e t o l o w e r e m p l o y m e n t a n d i n c o m e c o m b i n e d w i t h h i g h e r s i c k l e a v e . E x c e s s O A O - a t t r i b u t a b l e h e a l t h c a r e c o s t s w e r e 5.4 billion (¥769 billion), while additional pension payment spending of $0.5 billion (¥77 billion) was estimated, due to higher levels of early retirement. Conclusions: While the health implications of OAO are well documented, this fiscal analysis demonstrates the significant economic burden of OAO both to the healthcare system and broader government accounts. Policies aimed at reducing population-level obesity have the potential to benefit government accounts through increasing employment and reducing public spending, which can offset the cost of implementing these policies.

Long-term sickness absence trajectories among ageing municipal employees - the contribution of social and health-related factors

BACKGROUND

The ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA.

METHODS

Data comprised of municipal employees of the city of Helsinki aged 50-60 years during 2004-2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004-2018. All-cause and diagnosis-specific (mental disorder- and musculoskeletal disease-related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals).

RESULTS

A model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models.

CONCLUSIONS

Most ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Body mass index and sleep disturbances: a systematic review and meta-analysis

PURPOSE

Overweight and obesity have been common non-communicable diseases in recent years that have far-reaching health effects. This study aimed to study the risk of sleep disturbances based on overweight and obesity using a systematic review and meta-analysis.

VIEWS

Three sources of scientific information, namely PubMed, Scopus, and Embase, were selected as scientific databases and searched for articles published in English until May 2021. Also, a manual search on related articles was done. The resulting data required a meta-analysis based on odds ratios, which were extracted and then pooled. The odds ratio was calculated based on the random-effects method. Publication bias and the degree of heterogeneity were studied. Twenty-one longitudinal studies were selected for this meta-analysis. The odds ratio (OR) in this association between body mass index (BMI) ≥ 25 and sleep disturbances was 1.33 and the confidence interval (CI) was between 1.16-1.51. This OR was 1.12 and CI was between 0.98-1.29 in overweight. The OR was 1.24 and CI was between 1.07-1.44 in obesity. The OR was 1.92 and CI was between 0.89-4.15 in men. The OR was 1.47 and CI was between 1.15-1.89 in women. Publication bias and heterogeneity were evident in the meta-analysis.

CONCLUSIONS

Obesity increases the risk of sleep disturbances in the long term, and both obesity and sleep disturbances have negative effects on health, so it is necessary to develop appropriate interventions to improve obesity.

Prevalence of and factors associated with long-term sick leave in working-age adults with osteoarthritis: a retrospective cohort study conducted in Germany

PURPOSE

Little is known about the impact of osteoarthritis on the long-term work participation of working-age adults. Therefore, the goal of this study was to investigate the prevalence of and the factors associated with long-term sick leave in people newly diagnosed with osteoarthritis from Germany.

METHODS

This retrospective cohort study included patients aged 18-65 years diagnosed with osteoarthritis for the first time (index date) in 1 of 1198 general practices in Germany between 2016 and 2019 (Disease Analyzer database, IQVIA). Patients were considered to be on long-term sick leave if they were absent from work for medical reasons for more than 42 days in the year following the index date. Independent variables included sociodemographic characteristics, type of osteoarthritis, and frequent comorbidities. The association between these variables and long-term sick leave (dependent variable) was studied using an adjusted logistic regression model.

RESULTS

This study included 51,034 patients with osteoarthritis [mean (standard deviation) age 50.8 (9.2) years; 50.9% women]. The prevalence of long-term sick leave was 36.2%. Younger age and male sex were positively and significantly associated with long-term sick leave compared with older age and female sex, respectively. There was also a strong relationship between several comorbidities (e.g., reaction to severe stress, and adjustment disorders, gastritis and duodenitis, and depression) with long-term sick leave.

CONCLUSIONS

The prevalence of long-term sick leave was high in this sample of patients newly diagnosed with osteoarthritis from Germany. In this context, interventions should be implemented to increase the long-term working participation of people with osteoarthritis.

Obesity and sickness absenteeism among health workers in a private hospital in South Africa

Background

There is a worldwide trend among the general population including health workers to become more overweight and obese. Such obesity can reduce work ability as manifested through sickness absenteeism. The aim of this study was to describe the obesity among health workers in a private hospital in central South Africa, as measured by the body mass index (BMI) as well as the association of obesity and sickness absenteeism.

Methods

A cohort analytical study was conducted to describe changes in the BMI of employed health workers as well as the association of obesity and absenteeism in a private hospital in South Africa. The BMI measurement on employment, a repeat BMI at the time of the study as well as the sick leave days taken since employment of all health workers who had been employed for more than one year were analysed.

Results

Full time employees (n = 344) participated in the study of whom 33.7% were obese; 26.2% were overweight; 36.3% had normal weight and 3.7% were underweight at employment. On repeat BMI done in February 2016, 43.0% were obese; 27.6% were overweight; 28.2% had normal weight and 1.2% were underweight. There was no difference in the amount of sick leaves taken between the normal weight, overweight and obese groups.

Conclusion

A trend among health workers to change to a higher BMI category during employment is concerning, but there was no statistically significant association between the different weight groups and sickness absenteeism. The negative impact of obesity on the productivity of workers cannot be ignored.

Weight Reduction Interventions Using Digital Health for Employees with Obesity: A Systematic Review

PURPOSE

This study aimed to systematically review the literature on randomized controlled trials on weight reduction interventions using digital health for employees with obesity.

METHODS

All relevant articles published until September 2021 were systematically identified from six electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, RISS, and KISS. Data selection and extraction were independently performed by three researchers. Methodological quality was assessed using the JBI Critical Appraisal Checklist for Randomized Controlled Trials. The results were narratively synthesized.

RESULTS

Eleven studies were included in the systematic review. All studies had a low risk of bias. The settings and sample sizes of the included studies were different. The contents of the interventions included nutrition, physical activity, behavioral change, incentives, and motivation. Four studies were based on social cognitive theory. A total of ten studies delivered web-based intervention, while the other used tele-monitoring device. A wide range of intervention strategies was used including providing online resources, tele-counseling, and patient-tailored advice. As a result of the intervention, a total of seven studies showed a significant weight reduction in both the intervention and comparison groups, with significant differences between groups.

CONCLUSION

Until now, use of digital health in weight reduction interventions for employees with obesity has been conducted on a web-based. Various contents such as nutrition, physical activity and theories were explored. Further study is required using more diverse delivery methods such as mobile application, use of wearable devices.

Body weight and premature retirement: population-based evidence from Finland

BACKGROUND

Health status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement.

METHODS

The analyses were based on nationally representative data from Finland over the period 2001-15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education.

RESULTS

Excess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures.

CONCLUSION

Body weight outside a recommended range elevates the risk of premature retirement.

Depression symptoms and risk of sick leave: a systematic review and meta-analysis

OBJECTIVES

Depression symptoms are one of the most common psychiatric disorders and affect all aspects of life. The impact of depression symptoms on sick leave in the working population is a major issue that requires a more comprehensive examination.

METHODS

This systematic review used the PRISMA method to identify eligible studies (n = 15). Subsequently, the association between depression symptoms and sick leave was examined and several important subgroup analyses were performed.

RESULTS

Depression symptoms were associated with sick leave, with an overall risk ratio (RR) of 1.52 [95% confidence interval (95% CI) 1.34-1.73]. In men, the result displayed RR 2.19 (95% CI 1.17-4.09) and in women, the result showed RR 1.54 (95% CI 1.35-1.76). Additional subgroup analyses that account for methodological differences across studies based on the method of assessing depression symptoms and sick leave showed that this association was consistent.

CONCLUSION

Depression symptoms are associated with sick leave. Given that sick leave can have an economic and social burden, more attention to depression symptoms is necessary.

Influence of lifestyle risk factors on work ability and sick leave in a general working population in Norway: a 5-year longitudinal study

OBJECTIVES

The aim of this study is to assess (1) whether lifestyle risk factors are related to work ability and sick leave in a general working population over time, and (2) these associations within specific disease groups (ie, respiratory diseases, cardiovascular disease and diabetes, and mental illness).

SETTING

Telemark county, in the south-eastern part of Norway.

DESIGN

Longitudinal study with 5 years follow-up.

PARTICIPANTS

The Telemark study is a longitudinal study of the general working population in Telemark county, Norway, aged 16 to 50 years at baseline in 2013 (n=7952) and after 5-year follow-up.

OUTCOME MEASURE

Self-reported information on work ability (moderate and poor) and sick leave (short-term and long-term) was assessed at baseline, and during a 5-year follow-up.

RESULTS

Obesity (OR=1.64, 95% CI: 1.32 to 2.05) and smoking (OR=1.62, 95% CI: 1.35 to 1.96) were associated with long-term sick leave and, less strongly, with short-term sick leave. An unhealthy diet (OR=1.57, 95% CI: 1.01 to 2.43), and smoking (OR=1.67, 95% CI: 1.24 to 2.25) were associated with poor work ability and, to a smaller extent, with moderate work ability. A higher lifestyle risk score was associated with both sick leave and reduced work ability. Only few associations were found between unhealthy lifestyle factors and sick leave or reduced work ability within disease groups.

CONCLUSION

Lifestyle risk factors were associated with sick leave and reduced work ability. To evaluate these associations further, studies assessing the effect of lifestyle interventions on sick leave and work ability are needed.

Education differences in sickness absence and the role of health behaviors: a prospective twin study

BACKGROUND

Long-term sickness absences burden the economy in many industrialized countries. Both educational attainment and health behaviors are well-known predictors of sickness absence. It remains, however, unclear whether these associations are causal or due to confounding factors. The co-twin control method allows examining causal hypotheses by controlling for familial confounding (shared genes and environment). In this study, we applied this design to study the role of education and health behaviors in sickness absence, taking sex and cohort differences into account.

METHODS

Participants were two cohorts of in total 8806 Norwegian twins born 1948 to 1960 (older cohort, mean age at questionnaire = 40.3, 55.8% women), and 1967 to 1979 (younger cohort, mean age at questionnaire = 25.6, 58.9% women). Both cohorts had reported their health behaviors (smoking, physical activity and body mass index (BMI)) through a questionnaire during the 1990s. Data on the twins' educational attainment and long-term sickness absences between 2000 and 2014 were retrieved from Norwegian national registries. Random (individual-level) and fixed (within-twin pair) effects regression models were used to measure the associations between educational attainment, health behaviours and sickness absence and to test the effects of possible familial confounding.

RESULTS

Low education and poor health behaviors were associated with a higher proportion of sickness absence at the individual level. There were stronger effects of health behaviors on sickness absence in women, and in the older cohort, whereas the effect of educational attainment was similar across sex and cohorts. After adjustment for unobserved familial factors (genetic and environmental factors shared by twin pairs), the associations were strongly attenuated and non-significant, with the exception of health behaviors and sickness absence among men in the older cohort.

CONCLUSIONS

The associations between educational attainment, health behaviors, and sickness absence seem to be confounded by unobserved familial factors shared by co-twins. However, the association between health behaviors and sickness absence was consistent with a causal effect among men in the older cohort. Future studies should consider familial confounding, as well as sex and age/cohort differences, when assessing associations between education, health behaviors and sickness absence.

Association between job strain and sick leave: a systematic review and meta-analysis of prospective cohort studies

OBJECTIVES

Sick leave imposes large costs on society, and job strain is one of the factors leading to sick leave. A systematic review and meta-analysis of longitudinal studies was conducted to address job strain and its association with sick leave.

STUDY DESIGN

This is a systematic review and meta-analysis.

METHODS

PubMed and Scopus databases were reviewed, in addition to searches in Google Scholar and ResearchGate to ensure the inclusion of any grey literature articles. After screening the studies, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles, articles with longitudinal design were found desirable for meta-analysis. The risk ratio (RR) and 95% confidence interval (CI) were calculated, and publication bias was examined.

RESULTS

Eighteen longitudinal cohort studies were selected. Job strain and sick leave were found to be associated, and the RR of this association was equal to 1.44. Risk of sick leave based on job strain in men and women was equal to 1.66 (95% CI: 1.15-2.40) and 1.16 (95% CI: 1.08-1.24), respectively. The results showed no publication bias as per Begg's test.

CONCLUSIONS

Job strain was associated with an increased risk of sick leave. Occupational conditions have significant effects on the risk of sick leave-one of which is job strain. Therefore, improving organisational conditions can have a significant impact on reducing sick leave.

Body Mass Index (BMI) and Work Ability in Older Workers: Results from the Health and Employment after Fifty (HEAF) Prospective Cohort Study

This study explores associations between BMI and prolonged sickness absence; cutting down at work; and health-related job loss (HRJL) over two years of follow-up among workers aged ≥50 years. A cohort of 2299 men and 2425 women (aged 50–64 years) self-reported height and weight at baseline and provided information about work ability at 12 and 24 months for the Health and Employment after Fifty (HEAF) Study. Associations between BMI and work ability were assessed by logistic regression and HRJL by multiple-record Cox’s proportional hazards models, with adjustment for other risk factors. The prevalence of obesity/severe obesity was 22.6%/1.2% amongst men and 21.4%/2.6% amongst women, respectively. In men and women, obesity and severe obesity predicted having to cut down at work for health over two years. In women, severe obesity predicted prolonged sickness absence, and also HRJL even after adjustment for age, proximity to retirement, financial difficulties, and lifestyle factors (hazard ratio [HR] 2.93, 95% CI 1.38, 6.23), and additional adjustment for health conditions (HR 2.52, 95% CI 1.12, 5.67). Obesity, and particularly severe obesity, negatively impacts work ability amongst people aged 50–64 years, with greatest effects in women. Obesity can be expected to hinder attempts to encourage work to older ages.