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Changes in economic difficulties and subsequent sickness absence: a prospective register-linkage study
  1. Tea Lallukka1,2,
  2. Eero Lahelma1,
  3. Ossi Rahkonen1
  1. 1Department of Public Health, Hjelt Institute, University of Helsinki, Helsinki, Finland
  2. 2Finnish Institute of Occupational Health, Helsinki, Finland
  1. Correspondence to Dr Tea Lallukka; tea.lallukka{at}


Objectives People's economic difficulties are associated with their health, but consequences of changes in economic difficulties are less understood. We aimed to examine the associations between changes in economic difficulties and subsequent sickness absence while considering socioeconomic circumstances and other covariates.

Design A prospective cohort study.

Setting Helsinki, Finland.

Participants Municipal employees of the City of Helsinki, Finland (n=3859), who were respondents to the baseline (2000–2002) and follow-up (2007) questionnaire surveys and had register-based follow-up data on sickness absence until the end of 2010.

Primary and secondary outcome measures Self-certified short (1–3 days) and medically certified intermediate (4–14 days) and long (15+ days) sickness absence spells were examined using employer's personnel register data.

Results Persistent frequent economic difficulties predicted short (rate ratios (RR) 1.66 95% CI 1.49 to 1.86), intermediate (RR 2.13 95% CI 1.85 to 2.45) and long (RR 2.18 95% CI 1.75 to 2.70) sickness absence spells. Increasing economic difficulties similarly predicted sickness absence spells. The risks were somewhat stronger the longer the absence, and remained although attenuated somewhat after full adjustment. Weak risks were found also for persistent occasional economic difficulties and decreasing economic difficulties, and they attenuated further after full adjustments.

Conclusions Changes in economic difficulties predict subsequent sickness absence even after considering income, baseline health and other covariates. Thus economic difficulties should be considered when addressing causes of sickness absence.

  • employees
  • prospective
  • register-based
  • material hardship
  • work ability
  • socioeconomic position

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