title: Income inequality as a moderator of the relationship between psychological job demands and sickness absence, in particular in men: an international comparison of 23 countries.
abstract: OBJECTIVE
  The aim of this study was to investigate whether more sickness absence is reported in countries with higher income inequality than elsewhere, and whether the level of income inequality moderates the association between psycho-social job demands and sickness absence.
  
  
  METHODS
  Our analysis is based on the Fifth European Working Conditions Survey that compared 23 European countries. We performed multi-level regression analysis. On the macro-level of analysis we included the Gini-Index as measure of inequality. On the micro-level of analysis we followed the Karasek-Theorell model and included three scales for psychological job demands, physical job demands, and decision latitude in the model. The model was stratified by sex.
  
  
  RESULTS
  We found that, in countries with high income inequality, workers report significantly more sickness absence than workers in countries with low income inequality. In addition we found that the level of income inequality moderates the relationship between psychological job demands and sickness absence. High psychological job demands are significantly more strongly related to more days of sickness absence in countries with low income inequality than in countries with high income inequality.
  
  
  CONCLUSIONS
  As the nature and causal pathways of cross-level interaction effects still cannot be fully explained, we argue that future research should aim to explore such causal pathways. In accordance with WHO recommendations we argue that inequalities should be reduced. In addition we state that, particularly in countries with low levels of income inequality, policies should aim to reduce psychological job demands.
authors: Institute for Social Medicine and Epidemiology, Medical University Graz, Graz, Austria.
authors: Johanna
authors: J
authors: Muckenhuber
authors: Institute for Social Medicine and Epidemiology, Medical University Graz, Graz, Austria.
authors: Nathalie
authors: N
authors: Burkert
authors: Institute for Social Medicine and Epidemiology, Medical University Graz, Graz, Austria.
authors: Franziska
authors: F
authors: Großschädl
authors: Institute for Social Medicine and Epidemiology, Medical University Graz, Graz, Austria.
authors: Wolfgang
authors: W
authors: Freidl
mesh_terms: D017281:Cost of Illness; D003430:Cross-Sectional Studies; D006801:Humans; D055809:Illness Behavior; D007588:Job Satisfaction; D008297:Male; D018582:Sick Leave; D013315:Stress, Psychological