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Occupational Medicine & Health Affairs
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Determinants of Sick Leave Duration Following Occupational Injuries among Workers in the County of Gavleborg, Sweden

Leah Okenwa-Emegwa*

Department of Occupational and Public Health Sciences, University of Gävle, Sweden

*Corresponding Author:
Leah Okenwa Emegwa
Department of Occupational and Public Health Sciences
Faculty of Health and occupational studies
University of Gävle, Kungsbäcksvägen 47
room 55:410, 801 76 Gävle, Sweden
Tel: +46 26 645082
E-mail: [email protected]

Received date: May 06, 2014; Accepted date: September 05, 2014; Published date: September 09, 2014

Citation: Okenwa-Emegwa L (2014) Determinants of Sick Leave Duration Following Occupational Injuries among Workers in the County of Gävleborg, Sweden. Occup Med Health Aff 2:176. doi: 10.4172/2329-6879.1000176

Copyright: © 2014 Leah Okenwa-Emegwa This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Occupational injuries continue to add to the global burden of injuries. Recent global estimates show that up 317 million workers were injured in accidents at work that resulted in absence from work of four days or more. Whereas sick leave is important for rehabilitation and recovery, the duration of sick leave and consequent return to work is of concern in order to prevent negative outcomes. There is therefore a need to examine factors associated with sick leave duration among injured workers for effective rehabilitation. This study aimed to investigate the determinants of leave sick duration following occupational injuries. Method: The Swedish National Working Environment Agency keeps a record of all cases of occupational injuries requiring at least one day sick leave day and reported to Swedish Social Welfare Security Agency. The present study is register based using data from a total of 5291 cases of occupational injuries that occurred in the county of Gävleborg, Sweden between 2007 and 2012. Result: Sick leave longer than two weeks was highest for the self-employed and temporary workers although injury frequency was low for both groups. Fall injuries and injuries involving slip, trip and snapping or breaking of an object were more likely to lead to sick leave longer than two weeks. Shorter sick duration was observed among injured workers in the health and manufacturing sectors. Conclusions: Possible reasons for the observed results and the need for individual based rehabilitation process for effective and more meaningful return to work are discussed.

Keywords

Sick leave; Occupational injury; Return to work; Rehabilitation; Inequality, occupational sector; Employment

Background

Due to a growing economically active population, work related injuries have increased considerably and continue to contribute to the global burden of disease and injuries [1-4]. According to recent global estimates, over 96,00,00 workers are injured and 1020 die per day due to work related injuries [3]. Recent studies from the European Union show that the one year incidence of occupational injuries within the region’s approximately twenty countries is about 3.2% [5]. Globally, it is estimated that about 317 million workers were injured in accidents at work that resulted in absence from work of four days or more. This equates to an average of 850,000 injuries per day [6].

While sick leave is of great importance for the workers in terms of recovery, it is also a matter of concern due to its potential negative consequences to all stakeholders i.e. the individual, employer and society. At the individual level, research has shown that there is a significant risk of permanent disability and potential job loss [7,8]. Sick leave duration has been linked to disability pension and labour market exclusion [9]. Wang et al. in a 2013 study [10] found that sick leave was associated with suicide attempt and completed suicide. This association remained even after adjusting for previous mental healthcare, suicide attempt and present use of antidepressants among other factors. This risk for suicide attempt and suicide was also found to increase with longer sick leave duration [10]. At the company and societal level, loss of productivity for the time period and worker’s compensation are some of the known consequences of sick leaves. Up to 2.5% of the total gross national product (GNP) and between 3-6% working hours are lost due to sick leaves [11].

The acknowledgement of the importance of sick leave duration and an individual’s ability to return to work following sick leave has led to the development of screening methods for for this purpose. An example is the use of Readiness for return to work (RTW) scale results of which may be useful for tailoring occupational rehabilitation [12]. Some known determinants of length of sick leave duration following occupational injuries include age [13,14], gender [15,16], workplace bullying and violence [17]; education, occupational class and income [18] among others. In a study by Slany et al. [19], additional factors such as job problems or problems with colleagues were identified as possible determinants of return to work following sick leave. Identifying predictors of the potential length of sick leave may prove useful to not just the individual such as in enhancing job retention [8] and preventing disability, [7] but also economically relevant for employers and society.

Sweden

Different rules apply in different countries regarding worker compensation and support following sickness or occupational injuries. In Sweden a sick or injured worker backed by a medical certificate is entitled to eighty percent (80%) of their income for the period of their sick leave up to 364 days. Thereafter they become entitled to seventy five percent (75%) up to maximum 550 days. The employer is however responsible for the sick leave pay for the first two weeks after which the Swedish Social Insurance Agency takes over. The Swedish National Working Environment Agency keeps a record of all cases of work place injury reported to the Swedish Social Welfare Security Agency [20,21]. Although there are some studies exploring trends and patterns of occupational sick leaves in Sweden, most of them are either injury specific eg [22] or industry specific [17]. There is therefore a need to investigate how other types of injuries contribute to the overall burden and what role the injured worker’s occupational sector may play in determining sick leave duration. There are also very few studies exploring occupational injury patterns and distribution at county level, for example in Gävleborg county. Gävleborg is one of the twenty one counties in Sweden. It has a population of about 276,323 with a population density of about 15 per kilometer square [17]. Information about the duration of sick leave following occupational injuries may be useful for planning and prevention effort at the regional and local level.

The aim of this study is therefore to investigate the likely predictors of leave sick duration following occupational injuries.

Methods

Design and participants

The study is based on the register kept by the Swedish National Working Environment Agency. The register covers all cases of occupational injuries requiring at least one day of sick leave reported to the Swedish social security board. The classification system used is the Swedish standard classification system (In Swedish, SNI). The SNI system follows European standards for classification of occupations industrial sectors. The coding system is regularly reviewed and updated which means that codes change periodically. The latest update gave rise SNI 2007 which as the name implies has been in use since 2007 [23]. For the sake of homogeneity only cases classified using the most recent classification system were selected for this study i.e. cases that occurred between 2007 up to 2012. All cases of non fatal occupational accident among all categories of workplace as well as the self-employed were included giving rise to a total of 5291 participants.

Measures

Variables

Dependent variable

Sick leave following occupational injury

There were four broad categories for this in the original data file namely: 1-3 days; 4-14 days; longer than 14 days and death. For the purpose of this study, these classifications were recoded into two broad categories i.e. 1-14 days and longer than fourteen days, all fatalities were excluded.

Independent variables

The independent variables in the study include age, gender, industrial sector, employment status and cause of injury.

Data analysis

Data analysis was conducted using the statistical software SPSS. Descriptive analysis was used to show the length of sick leave due to occupational injury across the independent variables. Logistics regressions was used to assess the interactions between the variables with significance level set at p<0.005 and 95% confidence interval.

Ethical consideration

Ethical approval for the study was granted by the regional institutional review board.

Results

The study found duration of sick leave following occupational injuries in Gävleborg County to be related to age, gender, cause of injury, industrial sector age and gender. The frequency distribution of occupational injuries by varying factors is shown in table 1. The proportion of injured workers increased with age with workers in the 40-49 years and 50-59years age group accounting for a majority of the injuries (26.2% and 26.8% respectively). The proportion of injured men is almost twice that of women (61%), other factors with higher proportion of injuries include injuries due to loss of control ( 27.5%); manufacturing sector 34.0%); permanent staff (82%).

Variable n N %
Age
<20
20-29
30-39
40-49
50-59
60 and above                                   

166
820
914
1385
1420
586
5291  
3.1
15.5
17.3
26.2
26.8
11.1
Sex
Male
Female

3251
2040
5291
61.4
38.6
Cause of Injury
Loss of control
Fall
Movement involving load
Slip/snapping/splitting/breaking of an object
Violence
Movement not involving load
Electricity/fire/Explosion
Leakage/Radiation

1454
1385
416
283
642
791
42
78

5091

27.5
26.2
7.9
5.3
12.1
14.9
8.0
1.5
Industry
Agriculture/fishing/logging
Mining
Manufacturing
ELectricity/gas/stea/airconditioning
Watersupply/sewage/waste management/remedial
Construction
Whosale/retail trade/repair of vehicles&motorcycle
Transport & storage
Accomodation& Food service activities
Information and communication
Financial insurance activities
Real estate
Professional/scientic/technical activities
Administrative & support services
Public administration/compulsory social security
Education
Human health and social work
Arts/entertainment/recreation & other services
         
106
9
1801
19
49
490
255
363
74
15
12
75
64
254
218
392
966
90
5291
2.0
0-2
34.0
0.4
0.9
9.3
4.8
6.9
1.4
0.3
0.2
1.4
1.2
4.8
4.1
7.4
18.3
1.7
Employment Type
Self-employed and family members
Permanent employment
Student
Temporary

51
4339
86
777
 
1.0
82.0
1.6
14.7
Sickness Absence
1 – 3 days
4 – 14 days
>14days
Death

1344
1928
2006
13
5291
25.4
36.4
37.9
0.2

Table 1: Frequency distribution of occupational injuries requiring at least one day of sick leave, by demographic factors, occupational sector and cause of injury

Table 2 shows that the proportion of sickness leave was significantly related to specific factors. Like injury frequency, the proportion of workers who had sick leave longer than fourteen (14) days appears to increase with age. More proportions of men had sick leave duration longer than 14 days. Nearly half of all injuries due to fall (45.2%) and Slip/snapping/splitting/breaking of an object (46.5%) resulted in sick leave longer than 14 days. More than half of the injuries occurring in the agricultural (56.7%), mining (55.6%), real estate (57.4%) significantly led to sick leave longer than 14 days. From table 2, it can be seen that sick leave longer than fourteen days is higher among the self-employed and their family members (72%). All of the figures reached statistical significance.

Variable Sick leave longer than 14 days
       
N n % P-
value      
Age        
<20 166 22 13.3 0.000
20-29 818 228 27.9  
30-39 913 324 35.5  
40-49 1383 545 39.4  
50-59 1413 591 41.8  
60 and above 585 296 50.6  
Sex        
Male 3242 1304 40.2 0.000
Female 2036 702 34.5  
Cause of Injury        
Loss of control 1447 510 35.2 0.000
Fall 1385 626 45.2  
Movement involving load 416 149 35.8  
Slip/snapping/splitting/breaking of an object 282 131 46.5  
Violence        
Movement not involving load 641 222 34.6  
Electricity/fire/Explosion 791 267 33.8  
Leakage/Radiation 42 14 33.3  
  76 20 26.3  
Industry        
Agriculture/fishing/logging 104 59 56.7 0.000
Mining 9 5 55.6  
Manufacturing 1794 599 33.4  
ELectricity/gas/stea/airconditioning 19 7 36.8  
Watersupply/sewage/waste management/remedial 48 21 43.8  
Construction        
Whosale/retail trade/repair of vehicles&motorcycle 490 228 46.5  
Transport & storage 255 104 40.5  
Accomodation& Food service activities        
Information and communication 362 181 50  
Financial insurance activities 74 31 41.9  
Real estate        
Professional/scientic/technical activities 15 5 33.3  
Administrative & support services 12 0 0  
Public administration/compulsory social security 75 41 54.7  
Education 64 23 35.9  
Human health and social work        
Arts/entertainment/recreation & other services 254 104 40.9  
   218      84        38.5      
         
  392     133        33.9      
  964     327        33.9      
  90         42         46.7      
Employment status        
36 72 0.000
1667 38.5  
9 19.5  
286 37.8  
Self-employed and family members 50      
Permanent employment 4331      
Student 86      
Temporary 773      

Table 2: Proportions of sick leave duration longer than two weeks by demographic factors, occupational sector and cause of injury

Adjusted odds ratios for determinants of length of sickness absence are presented in Table 3. The results show that the odds of sickness absence longer than fourteen (14) days increased with age (<20yrs=0.214; 20-29=0.397; 30-39=0.575; 40-49=0.709; 50-59=0.778; 60 and above=1.000). Compared to females, Injured male workers were less likely to be away from work for periods longer than four days (OR=0.783). There was a twofold odds for longer sickness absence for injuries due to fall (OR=2.020) and Slip/snapping/splitting/breaking of an object (2.078).


Sick leave longer than 14 days
Variable Adjusted OR     CI for OR P-value
Age      
<20
20-29
30-39
40-49
50-59
60 and above
0.214
0.397
0.575
0.709
0.778
1.000
0.122 - 0.377
0.312 – 0.504
0.460 – 0.719
0.578 – 0.871
0.636 – 0.952
0.000
0.000
0.000
0.001
0.015
0.000
Sex      
Male
Female
0.783
1.000
0.668 – 0.919 0.003
Cause of Injury      
Loss of control 1.467 0.861 – 2.497 0.158
Fall 2.020 1.185 – 3.444 0.010
Movement involving load
Slip/snapping/splitting/breaking of an object
1.642
2.078
0.934 – 2.889
1.169 – 3.695
0.085
0.013
Violence 1.649 0.955 – 2.848 0.073
Movement not involving load 1.348 0.784 – 2.320 0.280
Electricity/fire/Explosion 1.172 0.501 – 2.742 0.714
Leakage/Radiation 1.000   0.000
Industry      
Agriculture/fishing/logging 1.246  0.685– 2.268 0.471
Mining 1.833 0.447 – 7.510 0.400
Manufacturing 0.558 0.356 – 0.873 0.011
ELectricity/gas/stea/airconditioning 0.613 0.213 – 1.769 0.366
Watersupply/sewage/waste management/remedial 0.838
0.405 - 1.731
0.632
Construction 0.911 0.566 - 1.467 0.701
Whosale/retail trade/repair of vehicles&motorcycle
Transport & storage
Accomodation& Food service activities
Information and communication
Financial insurance activities
Real estate
Professional/scientic/technical activities
Administrative & support services
Public administration/compulsory social security
Education
Human health and social work
Arts/entertainment/recreation & other services
0.829
1.153
0.989
0.468
0.000
1.136
0.657
0.784
0.741
0.683
0.592
1.00
0.501 – 1.371 0.708 – 1.878
0.518 – 1.886 0.145 – 1.505
0.00
0.599 – 2.154
0.330 – 1.309 0.474 – 1.297
0.438 – 1.254
0.419 – 1.116
0.374 – 0.938

0.464
0.567
0.973
0.202
0.999
0.695
0.232
0.344
0.265
0.128
0.025
0.000
Employment Type
Self-employed and family members
Permanent employment
Student
Temporary

2.172
0.875
0.420
1.000

1.112 – 4.240
0.733 – 1.045
0.178 – 0.987

0.023
0.140
0.045
0.005

Table 3: Adjusted odds ratio for sick leave duration: adjusted for age, sex, cause of injury, employment status and industrial sector

With regards to occupational sector, being a worker in the manufacturing or healthcare sector was a significant predictor of sick leave duration with workers in this sectors having lower odds for sick leave longer than two weeks (0.558; p=0.011 and 0.592; p=0.025) respectively. The sectors with the highest odd of longer sick leave were mining (1.833), agriculture (1.246), transport (1.153) and real estate (1.136) however, these did not reach statistical significance. It can also be seen from Table 3 that the self-employed, their family members and temporary workers were more likely to have been on sick leave longer than 14 days.

Discussion

Findings from the present study show that both injury frequency and sick leave duration are to a significant extent related to factors such as age, gender, cause of injury and occupational sector. Although the role of factors such as gender and age in relation to occupational injury occurrence has long been known [6,24], focus continues on these factors due to their role even in consequent injury outcomes. In line with similar research [19,25] but contrary to some other studies [26-28], the present study found that injury frequency increased with age. With regards to length of sick leave, the odds for longer sick leaves increased with age. Known reasons for this are due to age related complications and possible difficulty in redeploying older workers to other kinds of job tasks [29].

Compared to females, males in this study accounted for a larger proportion of the overall burden of injury, however, likelihood of sick leave longer sick longer than two weeks was higher for females than for men. Differences in the common or dominant type of occupations for males and females may explain the trend [30]. According to Mathews [31], gender differences in length of sick leave duration may be related to the unwittingly segregated labour market i.e. more men are found in physically more demanding job and more women in physically more strenuous job characteristics [31]. The overall effect is reflected in the differences in length of sick leave between men and women following work place injury even after controlling for other factors [30]. There is therefore a need for stakeholders to put the gender aspects of work conditions and the risk of longer sick leave into perspective.

Fall injuries and injuries involving slip and snapping, snipping or breaking of an object presented with the most significant and highest (i.e. two fold) odd for longer period of sick leave. There seems to be a general consensus in literature regarding the severity of fall injuries [32]. The finding is in line with previous studies [7] and also to a similar one conducted in Denmark by Jorgensen & Layrsen [33], in which falls were identified as one of the injury causes associated with the long sick leave. Although falls and injuries involving slipping are often categorized separately, studies have shown the interconnectedness of both i.e. that a slip may indeed precede a fall [34,35]. In developed countries, the burden of disability arising from this combination of occupational event is estimated to be between 20-40% of the total disability due to work related injuries and is associated with higher economic costs. One previous study from Sweden showed that 22% of injuries leading to disability were due to falls to a lower level [34]. This may in part explain the tendency for longer sick duration observed in this group, i.e. that the severity of fall injuries warrants longer recuperation time.

Two sectors i.e. manufacturing and healthcare standout due to the lower odds of injured workers in these sectors to be on sick leave longer than two weeks. Further studies may be needed to investigate the lower propensity for sick leave longer than two weeks observed among injured workers in the manufacturing and healthcare sectors, as reasons may differ for both groups. For example, previous studies in other context (non Scandinavian) have shown that the manufacturing sector is regarded as one sector with weaker job security [36]. Other studies point to evidences that injured workers in the manufacturing sector may be facing increased challenges in terms of job retention [8]. This may be due to reasons such as reluctance of managers to redeploy them, accept them when redeployed to other departments after having been away sick leave and shortcomings in the routines for maintaining contact with an injured worker on sick leave [8]. It may be of interest to find out what the true situation is in Sweden for manufacturing industries.

According to the sickness flexibility model [34], Individual worker’s attendance at work depends on their understanding of how they think they are expected to act, which in turn is related to their perceived environmental conditions and the consequences of being absent [37]. Although lower propensity for sick longer than two weeks seen in this study may be regarded as positive, studies have shown that returning to work in spite of being sick (also known as presenteeism), can lead to negative consequences such as high risk of coronary disorders [38]. Similar observation i.e. lower propensity to be on sick leave has been made within the healthcare profession [38]. Common reasons for this were commitment to duty, not wanting to burden colleagues, own ability for self-medication and rehabilitation and incentives [38,39]. A need to address this trend is necessary due to the known risk for negative outcomes already discussed above.

Despite injury frequency being lowest among the self-employed, sick leave longer than two weeks was significantly higher in this category compared to the others (OR=2.172; CI=1.112-4.240; There may be two possible explanations for this observation, first is that the low levels of injury occurrence in this group may be due to underreporting already shown in previous research [40,41]. Second, research has shown that due to complex bureaucracy, the self-employed in Sweden usually consider it a cheaper alternative to wait a few days after injury before applying for sickness benefits [42]. Sick leave longer than two weeks seen in the self-employed participants of this study is partly in contrast to what is previously about the self-employed in Sweden not having the luxury to be sick [41,42]. There may however be contextual contentions in this case as most of the previous research come from the agricultural sector. Still a need for review of policy can never be overemphasized in order to avoid creating inequalities in access to sick leave among different worker categories.

Another group of workers observed to have sick leave longer than two weeks in the present study is the temporary worker group. One plausible explanation may be that although injury occurrence among temporary workers is low, the severity of the injury may warrant longer stays at home. On the other hand it may also be possible that the effective and functional compensation program following work place injury in Sweden [20] may be attractive enough to make temporary workers not return to work. Foley et al. [43] found that temporary workers have higher compensation claims rate and more lost workdays compared to other groups. Indeed previous research from Sweden has shown that after controlling for other factors, being less than fifty percent part time employed is a likely predictor of being a candidate for disability pension claims [44]. These findings along with those of the present study may be pointing to possible indication that precarious job situations may in some ways be associated with longer or even permanent absence from work. The reason why this is so may require further investigation as longer sick leave may be pointing to an interplay between injury severity, economical coping strategies, job situation, sick leave and compensation claims.

Conclusion

Hill & Trist [45] in their explanation of the social approach to accidents describe accidents as both social as well as personal events, meaning that the relationship between employees and their place of work may in some way play a role in accident proneness and occurrence, the same may be true even for sick leave duration. According to Virtanen [46], the need for sick leave may sometimes be subjective and may be dependent on interplay between the worker’s true physical state and trends in the labour market. Longer sick leave in certain groups may therefore not simply be an indication of injury severity but rather an indication of inequalities in sick leave taking accross different employment status, industrial sector and job descriptions,. The explanation is that certain occupational branches may have better resources to take longer sick leaves than do others [36]. Although sick leave is necessary for full recovery and rehabilitation, physicians and occupational therapists agree that work ability following sickness or injury is an obscure and complex concept [47]. The reason behind this general consensus among is due largely to the interplay between the person, the context of life, the work, and the society [4]. Whereas efforts should be taken to ensure quick and smooth return to work, returning to work to soon may be a risk factor for recurrent or repeated sick leave. Repeated short spell sick leave has been found to be related to occupational structure, physical job demand, employment status and compensation [43,48]. There is therefore a need for continued and increased collaboration between different stakeholders in assessing individual cases. This will go a long way in ensuring individual based rehabilitation process for eventual effective and more meaningful return to work.

Acknowledgement

The author is grateful to the Swedish National Working Environment Agency for the provision of data and useful tips.

Funding

This study is funded by University of Gävle, Sweden.

Ethical Approval

Ethical approval for the study was granted by the institutional review board (IRB) for the region whose duty it is to ensure that studies are done in accordance to international ethical standards such as the Helsinki Declaration.

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