title: Lost work days in the 6 years leading to premature death from cardiovascular disease in men and women.
abstract: BACKGROUND
  It is unclear whether individuals experience specific patterns of morbidity prior to premature death from cardiovascular disease (CVD).
  
  
  METHODS
  We examined morbidity levels in the 6 years leading up to death from CVD in 37,397 men and 113,198 women under 65 years of age from the Finnish Public Sector study, with a particular focus on gender differences. Morbidity was assessed using lost days from work, extracted from register data on sickness leave and disability pension. Data on cause-specific mortality were obtained from national health registers.
  
  
  RESULTS
  During a median follow-up of 8.5 years, there were 361 CVD deaths (174 from ischaemic heart disease (ICD9 410-414, 427.5; ICD10 I21-I25, I46), 91 from stroke (ICD9 430, 431, 434; ICD10 I60-I60, I61, I63), and 96 from other diseases of circulatory system (ICD9 390-459; ICD10 I00-I99)). Women had lower morbidity than men over the 6 years preceding stroke deaths (RR for mean annual days=0.33 (95% CI 0.14-0.78)). For other causes of CVD mortality, there were no gender differences in morbidity rates prior to death. In men, those who died from CVD had substantially greater morbidity levels than matched controls through the entire 6-year period preceding death (rate ratio=3.59; 95% confidence interval 2.62-4.93). Among women, morbidity days were greater particularly in the year preceding death from stroke.
  
  
  CONCLUSIONS
  Our results on working age men and women suggest no gender differences in morbidity prior to death from heart disease and lower morbidity in women prior to death from stroke. These findings challenge the widespread belief that women experience more morbidity symptoms than men.
authors.affiliation: INSERM, U1018, Hôpital Paul Brousse, Bât 15/16, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France. Archana.Singh-Manoux@inserm.fr
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Noora
authors.initials: N
authors.lastname: Sjösten
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Hermann
authors.initials: H
authors.lastname: Nabi
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.forename: Tuula
authors.initials: T
authors.lastname: Oksanen
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000503:physiopathology*; D016022:Case-Control Studies; D003132:Commerce / Q000191:economics; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012737:Sex Factors; D012923:Social Class; D020521:Stroke / Q000401:mortality / Q000503:physiopathology
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