title: Local economy and sickness absence: prospective cohort study.
abstract: OBJECTIVE
  To investigate the effect of the local economy, as measured by municipal revenue and local unemployment rate, on sickness absence among the employed.
  
  
  METHODS
  A prospective cohort study of 60 160 public sector employees (46 081 women, 14 079 men) with ecological measures of municipal revenue and local unemployment rate 1999-2000 and individual measures of sickness absence at baseline 1999 and at follow up 2000-2001.
  
  
  RESULTS
  Among men and women, constantly poor local economy, as shown by low municipal revenue and high unemployment rate, was related to decreased self certified sickness absence rates. Local unemployment rate was a stronger predictor of self certified sickness absence than municipal revenue and the effect was stronger among men than among women. High unemployment rate predicted increased medically certified sickness absence among women.
  
  
  CONCLUSIONS
  Working in areas of poor local economy is associated with increased long term sickness absence but decreased probability to take a short term sick leave. Unemployment rate may have an effect on the threshold to take a sick leave in relation to minor illnesses even when area deprivation poses health risk to its residents. To prevent adverse health effects of presenteeism, working while ill, and to reduce medically certified sickness absence, potential benefits may be attained by improving economic conditions and re-employment in deprived areas.
authors.affiliation: Finnish Institute of Occupational Health, Department of Psychology, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland. marianna.virtanen@ttl.fi
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
authors.forename: Pekka
authors.initials: P
authors.lastname: Virtanen
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003132:Commerce; D017281:Cost of Illness; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*