Publications by authors named "Mònica Ubalde-López"

18 Publications

  • Page 1 of 1

History of work-related health problems in a population-based sample of women: An exploratory factor analysis.

Work 2021 ;68(3):563-576

EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.

Background: Beyond the health-enhancing effects, work also has the potential of causing or worsening different health conditions in the same individual. However, research on within-worker aggregation of work-related health problems is scarce.

Objective: To describe the history and aggregation of work-related health problems in a population-based sample of women.

Methods: A total of 4330 women were asked whether they had ever had "a physical or mental health problem that was caused or made worse by your work". The aggregation of work-related health problems was assessed using an exploratory factor analysis.

Results: Five groups were identified. Factor 1 included all items on musculoskeletal disorders - lower socioeconomic position, higher BMI, smokers and history of occupational accidents. Factor 2 included mental disorders together with headache and/or eyestrain - higher socioeconomic position. Factor 3 included the other disorders item with some loading from digestive disorders - older and public sector workers. Factor 4 included respiratory disorders - lower socioeconomic position and history of occupational accidents. Factor 5 included hearing and ear problems - blue-collar workers.

Conclusion: There was a relevant aggregation of work-related health problems, which may inform the selection of specific components for interventions that aim to improve women's work-related health.
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http://dx.doi.org/10.3233/WOR-203394DOI Listing
January 2021

Association between early working life patterns, in publicly and privately owned companies, and the course of future sickness absence due to mental disorders: a cohort study in Catalonia (Spain).

BMJ Open 2021 Feb 16;11(2):e040480. Epub 2021 Feb 16.

CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.

Objectives: To assess the relationship between early working life patterns, at privately and publicly held companies, and the course of sickness absence (SA) due to mental disorders.

Methods: Cohort study of workers aged 18-28 years, affiliated with the Spanish social security system, living in Catalonia, who had at least one episode of SA due to mental disorders between 2012 and 2014. Individual prior working life trajectories were reconstructed through sequence analysis. Optimal matching analysis was performed to identify early working life patterns by clustering similar individual trajectories. SA trajectories were identified using latent class growth modelling analysis. Finally, the relationship between early working life patterns and subsequent SA trajectories was assessed via multinomial logistic regression models.

Results: Among both men and women, four labour market participation (LMP) patterns were identified: stable permanent employment (reference group), increasing permanent employment, fluctuating employment and delayed employment. Among women, an increasing permanent employment pattern in early working life was related to a decrease of accumulated SA days over time (adjusted OR (aOR) 2.08; 95% CI 1.18 to 3.66). In men, we observed a trend towards a middle stable accumulation of SA days in those with fluctuating employment (aOR 1.25, 95% CI 0.57 to 2.74) or delayed employment (aOR 1.79; 95% CI 0.59 to 5.41). In both men and women, an early working life in big companies was related to a more favourable SA trajectory.

Conclusions: Early LMP patterns characterised by an increasing stability-decreased number of transitions between temporary contracts and lack of social security coverage towards permanent contracts-were related to a better future SA course due to mental diagnosis.
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http://dx.doi.org/10.1136/bmjopen-2020-040480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7888331PMC
February 2021

Correction to: Sickness absence trajectories following labour market participation patterns: a cohort study in Catalonia (Spain), 2012-2014.

BMC Public Health 2020 Oct 1;20(1):1493. Epub 2020 Oct 1.

Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.

An amendment to this paper has been published and can be accessed via the original article.
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http://dx.doi.org/10.1186/s12889-020-09544-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7530968PMC
October 2020

Sickness absence trajectories following labour market participation patterns: a cohort study in Catalonia (Spain), 2012-2014.

BMC Public Health 2020 Aug 27;20(1):1306. Epub 2020 Aug 27.

Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.

Background: Previous studies have focused on the relationship between employment pathways and health-related outcomes based on cross-sectional or longitudinal approaches. However, little is known about the cumulative effects of employment status mobility on sickness absence (SA) over time. The aim of the present study was to examine the association between prior labour market participation (LMP) patterns and SA trajectories from a life-course perspective.

Methods: This cohort study was based on a sample of 11,968 salaried workers living in Catalonia and affiliated with the Spanish Social Security system, who accumulated more than 15 days on SA in at least one quarter during 2012-2014. Individuals were grouped into three different working life stages: early (18-25 years), middle (26-35 years), and late (36-45 years). To identify LMP patterns, we applied sequence analysis and cluster analysis (2002-2011), and we used latent class growth modelling to identify SA trajectories (2012-2014). Finally, we applied multinomial logistic regression models to assess the relationship between LMP patterns and SA trajectories.

Results: The analyses yielded six LMP patterns: stable employment (value range: 63-81%), increasing employment (5-22%), without long-term coverage (7-8%), decreasing employment (4-10%), fluctuant employment (13-14%), and steeply decreasing employment (7-9%). We also identified four SA trajectories: low stable (83-88%), decreasing (5-9%), increasing (5-11%), and high stable (7-16%). However, the only significant association we identified for LMP patterns and SA trajectories was among young men, for whom an increasing employment pattern was significantly associated with a lower risk for increased days on SA (adjusted odds ratio: 0.21; 95% confidence interval: 0.05-0.96).

Conclusions: SA trajectories are generally not related to prior 10-year LMP patterns at any stage of working life. To disentangle this relationship, future research might benefit from considering working life transitions with a quality-of-work approach framed with contextual factors closer to the SA course.
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http://dx.doi.org/10.1186/s12889-020-09396-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7453716PMC
August 2020

Do birthrates contribute to sickness absence differences in women? A cohort study in Catalonia, Spain, 2012-2014.

PLoS One 2020 26;15(8):e0237794. Epub 2020 Aug 26.

Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.

Aims: This study explores the differences in sickness absence trends in women according to reproductive age group and medical diagnoses.

Methods: Data were obtained from two administrative registries: the Continuous Working Life Sample and the Catalonian Institute of Medical Evaluations from 2012 to 2014, containing 47,879 female employees. Incidence rates and incidence risk ratios derived from Poisson and negative binomial models were calculated to compare sickness absence trends among reproductive age groups based on Catalonian birthrates: early-reproductive (25-34 years old), middle-reproductive (35-44) and late-reproductive (45-54), according to diagnostic groups, selected diseases, type of contract, occupational category, and country of origin.

Results: Younger women show a higher incidence of overall sickness absence compared to late-reproductive-aged women. Incidence risk ratios of sickness absence decreased significantly from early-reproductive to late-reproductive age for low back pain, hemorrhage in early pregnancy, nausea and vomiting, and abdominal and pelvic pain.

Discussion: The higher incidence of sickness absence due to pregnancy-related health conditions in early-reproductive women compared to other reproductive age groups, may explain the sickness absence differences by age in women. Proper management of sickness absence related to pregnancy should be a goal to reduce the sickness absence gap between younger and older women.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237794PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449461PMC
October 2020

[Permanent disability and premature mortality in a cohort of affiliates with the Spanish Social Security, 2004-2015].

Gac Sanit 2021 Mar-Apr;35(2):130-137. Epub 2020 Jan 18.

CIBER de Epidemiología y Salud Pública (CIBERESP), España.

Objective: To describe a surveillance and monitoring system based on the analysis of the incidence rate of permanent disability (PD) and premature mortality (PM) in a sample of members of the Spanish Social Security.

Method: Study of three birth cohorts (1950-1959, 1960-1969 and 1970-1979) of people affiliated to the general Social Security system, included in the Continuous Sample of Labour Lives, who has been active for at least one day between 2004 and 2015 (N = 753,341). For each cohort, the annual incidence rates of PD and MP were estimated according to occupation and economic activity in women and men.

Results: Between 2004 and 2015 the rates of PI and MP showed higher values in men with respect to women in practically all cohorts of births, occupations and economic activities groups. The trend throughout the observation period was increasing, both in the incidence of PD and PM in men and women, for the three birth cohorts and for all occupational categories.

Conclusions: The results derived from this work allows the continuous monitoring of the temporal evolution of the incidence of permanent disability and premature mortality in a representative sample of social security affiliates.
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http://dx.doi.org/10.1016/j.gaceta.2019.09.011DOI Listing
January 2020

A hospital occupational diseases unit: an experience to increase the recognition of occupational disease.

Med Lav 2019 Aug 26;110(4):278-284. Epub 2019 Aug 26.

Center for Research in Occupational Disease, Universitat Pompeu Fabra.

Background: Under-reporting and recognition of occupational diseases is a problem in countries with workers' compensation schemes.

Objective: To describe the role of a public hospital Occupational Disease Unit (ODU) in Barcelona that resulted in improved reporting and official recognition of occupational diseases from 2010 to 2017.

Methods: Hospital physicians referred possible cases of work-related disease to the ODU, where in-depth medical evaluations were then performed, and a detailed report addressing causation was generated. Patients with confirmed cases of occupational disease were counselled and followed while pursuing official recognition and benefits claims by the Spanish Social Security System.

Results: Between 2010 and 2017, 149 cases were referred to the ODU for evaluation. Of these, 80 (53.7%) were confirmed to have an occupational disease, 54 (67.5%) patients pursued official recognition, and to date 26 (48.1%) have been recognized by the Social Security System. The recognition rate varied by diagnosis group (p=0.003), and was highest for skin diseases (71.4%) and cancer (66.7%), and lowest for hearing loss (29.4%) and musculoskeletal disorders (16.7%).

Conclusions: A hospital ODU can improve reporting and official recognition of occupational diseases that otherwise might not have been recognized. Expanding this experience to other Spanish and European hospitals could improve the efficiency of workers' compensation schemes and better support preventive policies.
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http://dx.doi.org/10.23749/mdl.v110i4.8138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809997PMC
August 2019

Trajectories of sickness absence among salaried workers: evidence from the WORKss cohort in Catalonia (Spain), 2012-2014.

BMJ Open 2019 07 3;9(7):e029092. Epub 2019 Jul 3.

Department of Experimental and Health Sciences, Centre for Research in Occupational Health (CiSAL), Pompeu Fabra University, Barcelona, Spain.

Objectives: Sickness absence (SA) is a widely studied integrated measure of health status. To better understand how SA behaves over time (SA trajectory) a longitudinal and individual-centred approach will allow identifying groups of individuals who share common characteristics. The aim of this study was to identify and describe SA trajectories and to assess employment conditions and diagnosis groups as determinants.

Setting: Working-life and sickness absence administrative records from a representative sample of affiliated with the Spanish Social Security system.

Participants: 38 420 workers affiliated with the Spanish Social Security system, born 1949 to 1969 or 1970 to 1990, resident in Catalonia who had SA between 2012 and 2014 (75 212 episodes).

Results: We identified three different SA trajectories in both birth cohorts for men and women: low-stable (86.2% to 90.8% of individuals), decreasing (4.4% to 5.9% of individuals) and increasing (4.1% to 8.7% of individuals) accumulated days of SA. The main characteristic of SA trajectories was the medical diagnosis group. The increasing SA trajectory had a higher proportion of workers with SA due to mental disorders compared with the other trajectories. The association analysis showed diagnosis group strongly related with all SA trajectories, particularly SA due to mental disorders showed the strongest association with the increasing trajectory among young men (adjusted OR (aOR): 42.40, 95% CI 17.03 to 105.57). Low salary levels exhibited a strong relationship with decreased accumulation of SA days over time for old women (aOR: 2.08, 95% CI 1.36 to 3.18) and men (aOR: 2.75, 95% CI 1.77 to 4.27). Unskilled manual occupations were associated with increasing trajectories among young women (aOR: 1.36, 95% CI 1.01 to 1.84). No significant differences were observed for other employment conditions across trajectories.

Conclusions: Workers with mental disorders are more likely to have increased days of SA, whereas low salary levels at later ages are related to a decrease in SA days over time. Special attention to preventing the course of mental disorders at young and middle age is warranted.
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http://dx.doi.org/10.1136/bmjopen-2019-029092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6615827PMC
July 2019

Labor market situation after an episode of sickness absence due to malignant neoplasia. Evidence from a Spanish cohort.

BMC Public Health 2019 May 3;19(1):506. Epub 2019 May 3.

Center for Research in Occupational Health (CiSAL), Pompeu Fabra University, Barcelona, Spain.

Background: Due to the progress in screening and cancer treatments, survivor's prognosis has improved enabling a more likely return to work. However, return to work after a cancer diagnosis may be complex because of an unbalanced health status and work demands relationship that may push them out of the labor market. The aim of this study is to assess the risk of dropping out of the labor market due to unemployment, partial retirement, and permanent disability during the year following an episode due to a malignant neoplasm compared to other non-malignant pathologies.

Methods: Cohort study of 9699 workers affiliated with the Social Security System in Catalonia, who had a sickness absence episode between 2012 and 2013 due to malignant neoplasm, mental, musculoskeletal disorders, cardiovascular diseases and injuries. Competing risk regression models were applied to assess the risk of dropping out of the labor market, by calculating subhazard ratios (SHR) in both sexes. Models were adjusted for age, occupational category, type of contract, economic activity, annual median salary and duration of the SA episode as potential confounders.

Results: Sickness absence due to malignant neoplasia represented 1.7% out of the 9699 episodes included between 2012 and 2013. Although, 80% of individuals continued working in the year following an episode due to malignant neoplasm, women showed a trend towards exiting the labor market because of partial retirement [SHR = 8.4(1.5-45.5)] and permanent disability [SHR = 5.8(1.5-22.9)] compared to non-malignant pathologies. There were no significant differences for unemployment either in women [SHR = 0.4(0.2-0.9)] and in men [SHR = 0.2(0.1-0.6)].

Conclusions: Although return to work is a common pathway among cancer survivors, partial retirement and permanent disability seem to be potential pathways to exit the labor market among women.
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http://dx.doi.org/10.1186/s12889-019-6792-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6499967PMC
May 2019

[TRENDS IN OCCUPATIONAL INJURY AND DISEASE IN ARGENTINA, 1997-2015].

Arch Prev Riesgos Labor 2019 Jan to Mar;22(1):18-24

Centro de Investigación en Salud Laboral (CISAL), Universidad Pompeu Fabra, IMIM Parc Salut Mar, Barcelona, Spain.

Objectives: To describe temporal trends in occupational injuries (OI) and occupational diseases (OD) in Argentina, by severity of the injury, place of occurrence, economic activity and selected provinces, in the period 1997 to 2015.

Methods: The study population consists of the working population covered by the Argentine Law of Occupational Risks system, roughly 4 million people in 1997 and 9.5 million in 2015. The annual incidence rate of the OI and OD was calculated by using the number of reported cases divided by the mean number of employees covered by the system each year. To measure change in incidence over time, we calculated the overall percentage change (OPC), by dividing the difference between the incidence rate of the first minus the last year by the incidence rate of the last year.

Results: The overall incidence of OI and OD showed a greater decline for fatal (OPC=-65%) versus nonfatal injuries (OPC-23,3%). By place of occurrence, we observed a decrease in the incidence of nonfatal occupational injuries at the workplace (OPC =-47,7%), but an increase in occupational commuting OI (OPC =+123,4%). For OD, there was an increase in the incidence of nonfatal OD (OPC =393%), although the tendency showed both increases and declines among fatal occupational diseases. This pattern was consistent among different economic activities as well as in selected provinces.

Conclusions: Observed trends are in line with other high-income countries, with decreasing nonfatal workplace OI, and increasing commuting OI and nonfatal OD. Further in-depth research is warranted on temporal trends in non-fatal OD.
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http://dx.doi.org/10.12961/aprl.2019.22.01.4DOI Listing
September 2018

Beyond Return to Work: The Effect of Multimorbidity on Work Functioning Trajectories After Sick Leave due to Common Mental Disorders.

J Occup Rehabil 2017 06;27(2):210-217

Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Objectives Patients with common mental disorders (CMDs) often suffer from comorbidities, which may limit their functioning at work. We assessed the longitudinal impact of multimorbidity, defined as two or more co-occurring chronic health conditions, on work functioning over time among workers who had returned to work after sick leave due to CMDs. Methods Prospective cohort study of 156 workers followed for 1 year after return to work from sick leave due to CMDs. A multimorbidity score was computed by counting severity-weighted chronic health conditions measured at baseline. Work functioning was measured at baseline and at 3, 6 and 12 months follow-up with the Work Role Functioning Questionnaire. Work functioning trajectories, i.e. the course of work functioning after return to work over time, were identified through latent class growth analysis. Results A total of 44 % of workers had multimorbidity. Four work functioning trajectories were identified: one (12 % of the workers) showed increasing work functioning scores during follow-up, whereas the other trajectories showed low, medium and high scores (23, 41 and 25 %, respectively) that remained stable across time points. Although multimorbidity did not predict membership in any trajectory, within the increasing score trajectory levels of work functioning were lower among those with high baseline multimorbidity score (p < 0.001). Conclusions Over time, multimorbidity negatively impacts work functioning after return to work from sick leave due to CMDs.
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http://dx.doi.org/10.1007/s10926-016-9647-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5405093PMC
June 2017

[Response: Return to work after musculoskeletal disorders: a systematic review of good practices guidelines].

Arch Prev Riesgos Labor 2015 Jul-Sep;18(3):148-9

CISAL-Centro de Investigación en Salud Laboral, Universitat Pompeu Fabra, CIBER Epidemiología y Salud Pública (CIBERESP), Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain,

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http://dx.doi.org/10.12961/aprl.2015.18.3.06DOI Listing
July 2016

Has the Spanish economic crisis affected the duration of sickness absence episodes?

Soc Sci Med 2016 07 7;160:29-34. Epub 2016 May 7.

CISAL-Center for Research in Occupational Health, Universitat Pompeu-Fabra, Doctor Aiguader 88, 08003 Barcelona, Barcelona, Spain; CIBERESP, CIBER in Epidemiology and Public Health, Av. Monforte de Lemos, 3-5. Pabellón 11. Planta 0, 28029 Madrid, Spain; IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain. Electronic address:

The global economic crisis has had particularly intense effects on the Spanish labor market. We investigated whether the duration of non-work related sickness absence (SA) episodes in salaried workers had experienced any changes before and after the crisis started. This was a repeated cross-sectional analysis conducted in a dynamic cohort in 2006 and 2010. Database was provided by eight mutual insurance companies, covering 983,108 workers and 451,801 SA episodes. Descriptive analysis and crude, bivariate and multivariate analyses using Cox proportional hazards modeling were performed, to quantify the changes in duration of SA episodes between 2006 and 2010, stratified by sex. There was a higher number of episodes in 2010 for both sexes, but especially for women. Unadjusted median duration in men was similar for both years, while for women it was shorter in 2010. Final multivariate models show a greater risk of longer episode duration for men in 2010 (HR 0.95; 95% CI, 0.95-0.95), but a shorter one for women (HR 1.07; 95% CI, 1.07-1.07). Once the economic crisis started affecting the Spanish labor market, the number of SA episodes in women equalized with those in men. There was a decrease of episodes in the youngest age groups, in the construction and in temporary contracts. The relative ranking of leading diagnoses was similar in both years with an increase in infectious, nervous system and respiratory diseases and in mental disorder episodes for both sexes, but especially for women. The risk of longer episode duration was greater in 2010 among men, but smaller in women.
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http://dx.doi.org/10.1016/j.socscimed.2016.05.009DOI Listing
July 2016

Sickness absence among health workers in belo horizonte, brazil.

J Occup Health 2016 May 24;58(2):179-85. Epub 2016 Mar 24.

Program of Public Health, Faculty of Medicine, Universidade Federal de Minas Gerais (UFMG).

Objectives: To describe the prevalence of sickness absence and to analyze factors associated with the outcome according to gender in a sample of healthcare workers at the Belo Horizonte Health Department.

Method: This study was based on a Belo Horizonte Health Department survey carried out between September 2008 and January 2009. From a randomly selected sample of 2,205 workers, 1,808 agreed to participate. Workers were classified into Health Staff or Health Care. Other explanatory variables were social and demographic data, work characteristics, and personal health. The Poisson regression was applied to analyze factors associated with sickness absence by the prevalence ratio (PR).

Results: The overall prevalence of sickness absence was 31.5% (23.8% for men and 34.6% for women). In the final model, we found higher rates of sickness absence in both male and female workers involved in tasks with high psychosocial demands (PR=1.86 men; PR=1.38 women) and in those that reported using medication for treating chronic diseases (PR=1.96 men; PR=1.50 women). Women having a permanent job contract had a higher prevalence of sickness absence than those having a temporary job contract (PR=1.71).

Conclusion: Our findings suggest a paradox in how healthcare is organized: good results in terms of its global objective of providing healthcare for citizens contrast with lack of effective measures for protecting healthcare workers.
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http://dx.doi.org/10.1539/joh.15-0121-OADOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356964PMC
May 2016

Measuring multimorbidity in a working population: the effect on incident sickness absence.

Int Arch Occup Environ Health 2016 May 28;89(4):667-78. Epub 2015 Nov 28.

CISAL-Center for Research in Occupational Health, Universitat Pompeu Fabra, Av Dr Aiguader, 88, PRBB building, 1st floor, Barcelona, Spain.

Purpose: Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations.

Methods: Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes.

Results: Two dimensions in the MCA explained about 80% of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15%) and two or more (i.e., multimorbidity) (12 vs 2%). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident.

Conclusions: A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes.
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http://dx.doi.org/10.1007/s00420-015-1104-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4828479PMC
May 2016

Cross-national comparisons of sickness absence systems and statistics: towards common indicators.

Eur J Public Health 2014 Aug 11;24(4):663-6. Epub 2014 Jun 11.

1 Southwest Center for Occupational and Environmental Health, School of Public Health, The University of Texas Health Science Center at Houston, Texas, USA2 Center for Research in Occupational Health (CiSAL), University Pompeu Fabra, Barcelona, Spain3 CIBER in Epidemiology and Public Health, Spain.

We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons.
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http://dx.doi.org/10.1093/eurpub/cku070DOI Listing
August 2014

Influence of new secondary diagnoses on the duration of non-work-related sickness absence episodes.

J Occup Environ Med 2013 Apr;55(4):460-4

Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain.

Objective: To describe the frequency and distribution of new diagnoses (codiagnoses) arising during a sickness absence (SA) episode, and to analyze their effect on duration of non-work-related SA in Spain.

Methods: Prospective cohort study from 2004 to 2007. Overall, 15,246 episodes occurred in a population base of 632,000 workers. Median duration of the episodes was the measured outcome. A Cox survival analysis, stratified by sex, estimated the hazard ratio to case closure adjusting by initial diagnosis, codiagnoses, demographic, and employment-related variables.

Results: The effect of an increasing number of codiagnoses on duration of the SA episode was evidenced by a progressively decreasing hazard ratio. This was present in both sexes, although the effect was greater in men.

Conclusions: New conditions arising in the course of a SA episode significantly prolong its duration.
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http://dx.doi.org/10.1097/JOM.0b013e3182821b43DOI Listing
April 2013