title: Influence of lifestyle factors on long-term sickness absence among female healthcare workers: a prospective cohort study.
abstract: BACKGROUND
  While previous research has indicated that unhealthy lifestyle is associated with sickness absence, this association may be confounded by occupational class. To avoid this potential confounding, we examined the association between lifestyle factors (smoking, leisure-time physical activity and body mass index) and the occurrence of long-term sickness absence (LTSA; more than three consecutive weeks of registered sickness absence) within a cohort of female health care workers.
  
  
  METHODS
  A total of 7401 employees filled out a questionnaire about their health behaviour and work environment. Subsequently, they were followed for 12 months in a national register on social transfer payments (DREAM register). Cox's regression analyses, applied to grouped survival data, were used to estimate the prospective association between these lifestyle factors and LTSA.
  
  
  RESULTS
  We found significant associations between all three lifestyle factors and risk of LTSA. The strongest lifestyle factor was current smoking, which increased the risk of LTSA by 35% (95% CI: 1.17-1.54) compared to non- smokers. For body mass index, the risk of LTSA increased with the distance away from 18.5 kg/m2 in either direction (below 18.5 kg/m2: HR: 1.32 per kg/m2; 95% CI. 1.06-1.66; above 18.5 kg/m2: HR: 1.04 per kg/m2; 95% CI: 1.03-1.05). In other words, the more underweight or overweight the women were, the higher the risk of LTSA. A dose-response relationship was found between LTSA and leisure-time physical activity (trend test p-value = 0.01), so that increasing physical activity results in decreasing risk of LTSA.
  
  
  CONCLUSIONS
  In female healthcare workers, an unhealthy lifestyle (too high/ too low body mass index, smoking, and low physical activity) is associated with higher risk of LTSA.
authors.affiliation: National Research Centre for the Working Environment, Lerso Parkallé 105, 2100 Copenhagen, Denmark. hgq@nrcwe.dk.
authors.forename: Helle Gram
authors.initials: HG
authors.lastname: Quist
authors.forename: Birthe L
authors.initials: BL
authors.lastname: Thomsen
authors.forename: Ulla
authors.initials: U
authors.lastname: Christensen
authors.forename: Thomas
authors.initials: T
authors.lastname: Clausen
authors.forename: Andreas
authors.initials: A
authors.lastname: Holtermann
authors.forename: Jakob B
authors.initials: JB
authors.lastname: Bjorner
authors.forename: Lars L
authors.initials: LL
authors.lastname: Andersen
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009043:Motor Activity; D050177:Overweight / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018582:Sick Leave / Q000706:statistics & numerical data*; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013851:Thinness / Q000453:epidemiology*; D055815:Young Adult