title: Diagnosis-specific sickness absence as a predictor of mortality: the Whitehall II prospective cohort study.
abstract: OBJECTIVE
  To investigate whether knowing the diagnosis for sickness absence improves prediction of mortality.
  
  
  METHODS
  Prospective cohort study established in 1985-8. Sickness absence records including diagnoses were obtained from computerised registers.
  
  
  METHODS
  20 civil service departments in London.
  
  
  METHODS
  6478 civil servants aged 35-55 years.
  
  
  METHODS
  All cause, cardiovascular, and cancer mortality until 2004, average follow-up 13 years.
  
  
  RESULTS
  After adjustment for age, sex, and employment grade, employees who had one or more medically certified spells of sickness absence (>7 days) in a three year period had a mortality 1.7 (95% CI 1.3 to 2.1) times greater than those with no medically certified spells. Inclusion of diagnoses improved the prediction of all cause mortality (P=0.03). The hazard ratio for mortality was 4.7 (2.6 to 8.5) for absences with circulatory disease diagnoses, 2.2 (1.4 to 3.3) for surgical operations, and 1.9 (1.2 to 3.1) for psychiatric diagnoses. Psychiatric absences were also predictive of cancer mortality (2.5 (1.3 to 4.7)). Associations of infectious, respiratory, and injury absences with overall mortality were less marked (hazard ratios from 1.5 to 1.7), and there was no association between musculoskeletal absences and mortality.
  
  
  CONCLUSIONS
  Major diagnoses for medically certified absences were associated with increased mortality, with the exception of musculoskeletal disease. Data on sickness absence diagnoses may provide useful information to identify groups with increased health risk and a need for targeted interventions.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London. j.head@ucl.ac.uk
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Kristina
authors.initials: K
authors.lastname: Alexanderson
authors.forename: Hugo
authors.initials: H
authors.lastname: Westerlund
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000041:Absenteeism; D000288:Administrative Personnel / Q000706:statistics & numerical data; D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D006801:Humans; D008131:London / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality*; D009784:Occupational Diseases / Q000401:mortality*; D018582:Sick Leave / Q000706:statistics & numerical data*; D018875:Vocabulary, Controlled