title: Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors.
abstract: OBJECTIVE
  To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors.
  
  
  METHODS
  All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated.
  
  
  RESULTS
  We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32).
  
  
  CONCLUSIONS
  County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.
authors: Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Red de investigacion en servicios de salud en enfermedades cronicas (REDISSEC), Spain; Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain. Electronic address: isatr10279@gmal.com.
authors: Isabel
authors: I
authors: Torá-Rocamora
authors: Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain.
authors: José Miguel
authors: JM
authors: Martínez
authors: Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain; Southwest Center for Occupational and Environmental Health, Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, San Antonio Campus. San Antonio, Texas, USA.
authors: David
authors: D
authors: Gimeno
authors: Institut Català d'Avaluacions Mèdiques i Sanitàries, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
authors: Constança
authors: C
authors: Alberti
authors: Institut Català d'Avaluacions Mèdiques i Sanitàries, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
authors: Josefina
authors: J
authors: Jardí
authors: Medical and Health Care Services Division. Mutual Midat Cyclops (MC MUTUAL). Barcelona, Spain.
authors: Rafael
authors: R
authors: Manzanera
authors: Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain.
authors: Fernando G
authors: FG
authors: Benavides
authors: Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain; Southwest Center for Occupational and Environmental Health, Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA.
authors: George
authors: G
authors: Delclos
mesh_terms: D000293:Adolescent; D000328:Adult; D003953:Diagnosis-Related Groups; D005260:Female; D062306:Geography, Medical; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D017678:Sex Distribution; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013030:Spain; D055815:Young Adult
keywords: Análisis multilevel; Biological characteristics; Características biológicas; Características sociales; Incapacidad temporal; Multilevel analysis; Occupational health; Salud laboral; Sick leave; Social characteristics
references: Scand J Prim Health Care. 2008;26(1):22-8
references: 18297559
references: J Epidemiol Community Health. 2005 Dec;59(12):1022-8
references: 16286487
references: Work. 2007;28(2):153-64
references: 17312347
references: Scand J Soc Med. 1986;14(4):183-95
references: 3787212
references: Gac Sanit. 2010 May-Jun;24(3):215-9
references: 20206417
references: J Epidemiol Community Health. 1995 Apr;49(2):124-30
references: 7798038
references: Gac Sanit. 2013 Jan-Feb;27(1):81-3
references: 22657870
references: PLoS One. 2013;8(2):e56674
references: 23437208
references: J Occup Rehabil. 2010 Mar;20(1):113-21
references: 20052523
references: Work. 2013;45(3):305-9
references: 23241695
references: J Occup Environ Med. 2006 Nov;48(11):1181-8
references: 17099455
references: Scand J Public Health Suppl. 2004;63:36-43
references: 15513652
references: J Epidemiol Community Health. 2005 Sep;59(9):729-36
references: 16100308
references: Eur J Public Health. 2008 Jun;18(3):224-31
references: 18245150
references: Work. 2008;30(4):377-87
references: 18725701
references: Am J Epidemiol. 2007 Jan 1;165(1):22-6
references: 16973762
references: Am J Epidemiol. 2005 Jan 1;161(1):81-8
references: 15615918
references: J Epidemiol Community Health. 2007 Apr;61(4):349-55
references: 17372297
references: Rev Esp Salud Publica. 2010 Jan-Feb;84(1):61-9
references: 20376414
references: Scand J Soc Med. 1998 Dec;26(4):241-9
references: 9868747
references: J Epidemiol Community Health. 2005 Jun;59(6):443-9
references: 15911637
references: J Occup Rehabil. 2005 Sep;15(3):273-84
references: 16119220
references: Am J Epidemiol. 2011 Oct 1;174(7):828-38
references: 21836166
references: J Occup Rehabil. 2005 Dec;15(4):453-7
references: 16254748
references: Rev Esp Salud Publica. 2012 May-Jun;86(3):213-7
references: 22991078
references: Scand J Public Health Suppl. 2004;63:256-8
references: 15513661
references: Health Place. 2009 Mar;15(1):308-14
references: 18692427
references: Int Arch Occup Environ Health. 2011 Apr;84(4):445-52
references: 21190032
references: Eur J Public Health. 2004 Dec;14(4):406-12
references: 15542878
references: Annu Rev Public Health. 2000;21:171-92
references: 10884951
references: Spine (Phila Pa 1976). 2003 Jul 1;28(13):1468-73; discussion 1473-4
references: 12838108
references: Rev Esp Salud Publica. 2009 May-Jun;83(3):453-61
references: 19701576
references: J Epidemiol Community Health. 2006 Apr;60(4):290-7
references: 16537344
references: Gac Sanit. 2012 Jul-Aug;26(4):343-51
references: 22244269
references: J Epidemiol Community Health. 2003 Aug;57(8):550-2
references: 12883048