title: Working while ill as a risk factor for serious coronary events: the Whitehall II study.
abstract: OBJECTIVE
  Although sick, some people take no time off work, a phenomenon called "sickness presenteeism." This study examined the association between sickness presenteeism and incidence of serious coronary events.
  
  
  METHODS
  The analyses were based on a cohort of 5071 male British civil servants without previous myocardial infarction. Baseline screening included measurements of health status and coronary risk factors. Absence records were assessed for the 3 years subsequent to baseline screening. The outcome of interest was incident nonfatal myocardial infarction or fatal coronary heart disease (mean length of follow-up=9.1 years).
  
  
  RESULTS
  Seventeen percent of unhealthy employees took no absence during the 3-year follow-up. Their incidence of serious coronary events was twice as high as that of the unhealthy employees with moderate levels of sickness absenteeism (after adjustment for conventional risk factors, hazard ratio 1.97, 95% confidence interval=1.02, 3.83).
  
  
  CONCLUSIONS
  Employers and employees should be aware of the potential harmful effects caused by sickness presenteeism.
authors.affiliation: Department of Psychology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland. mika.kivimaki@ttl.fi
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Harry
authors.initials: H
authors.lastname: Hemingway
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
mesh_terms: D000328:Adult; D003327:Coronary Disease / Q000209:etiology*; D006304:Health Status; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology*; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology