title: Changes in economic difficulties and subsequent sickness absence: a prospective register-linkage study.
abstract: OBJECTIVE
  People's economic difficulties are associated with their health, but consequences of changes in economic difficulties are less understood. We aimed to examine the associations between changes in economic difficulties and subsequent sickness absence while considering socioeconomic circumstances and other covariates.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Helsinki, Finland.
  
  
  METHODS
  Municipal employees of the City of Helsinki, Finland (n=3859), who were respondents to the baseline (2000-2002) and follow-up (2007) questionnaire surveys and had register-based follow-up data on sickness absence until the end of 2010.
  
  
  METHODS
  Self-certified short (1-3 days) and medically certified intermediate (4-14 days) and long (15+ days) sickness absence spells were examined using employer's personnel register data.
  
  
  RESULTS
  Persistent frequent economic difficulties predicted short (rate ratios (RR) 1.66 95% CI 1.49 to 1.86), intermediate (RR 2.13 95% CI 1.85 to 2.45) and long (RR 2.18 95% CI 1.75 to 2.70) sickness absence spells. Increasing economic difficulties similarly predicted sickness absence spells. The risks were somewhat stronger the longer the absence, and remained although attenuated somewhat after full adjustment. Weak risks were found also for persistent occasional economic difficulties and decreasing economic difficulties, and they attenuated further after full adjustments.
  
  
  CONCLUSIONS
  Changes in economic difficulties predict subsequent sickness absence even after considering income, baseline health and other covariates. Thus economic difficulties should be considered when addressing causes of sickness absence.
authors.affiliation: Department of Public Health,  Hjelt Institute,  University of Helsinki, Helsinki,  Finland.
authors.forename: Tea
authors.initials: T
authors.lastname: Lallukka
authors.forename: Eero
authors.initials: E
authors.lastname: Lahelma
authors.forename: Ossi
authors.initials: O
authors.lastname: Rahkonen