title: Increased sickness absence in diabetic employees: what is the role of co-morbid conditions?
abstract: OBJECTIVE
  Diabetes is thought to be associated with increased risk of sickness absence in working populations. We examined the contribution of co-morbidity to this association.
  
  
  METHODS
  Records of physician-certified sickness absence episodes (> 3 days) over a 1-year period were obtained from employers' records after a survey of chronic diseases and risk factors in 638 diabetic and 32 510 non-diabetic public sector employees in Finland (the Public Sector Study).
  
  
  RESULTS
  Diabetic employees had a 2.15-fold (95% confidence interval 1.92-2.40) age- and sex-adjusted excess risk of sickness absence compared with their colleagues with no chronic disease. In absolute terms, diabetes was related to 59 extra absence episodes per 100 person years. Of this excess risk, 55% was attributable to co-occurring non-cardiovascular diseases, such as depression, prolapsed intervertebral disc and bronchitis. The contribution of cardiovascular complications to the excess sickness absence was small (7%).
  
  
  CONCLUSIONS
  In this occupational cohort, the excess risk of sickness absence in diabetic employees was largely accounted for by non-cardiovascular co-morbidity. Intervening multiple chronic conditions may be important in programmes to reduce sickness absence in diabetic employees.
authors.affiliation: International Institute for Society and Health, Department of Epidemiology and Public Health, University College London, London, UK. m.kivimaki@ucl.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Kivimäki
authors.forename: J
authors.initials: J
authors.lastname: Vahtera
authors.forename: J
authors.initials: J
authors.lastname: Pentti
authors.forename: M
authors.initials: M
authors.lastname: Virtanen
authors.forename: M
authors.initials: M
authors.lastname: Elovainio
authors.forename: H
authors.initials: H
authors.lastname: Hemingway
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies