title: Measuring multimorbidity in a working population: the effect on incident sickness absence.
abstract: OBJECTIVE
  Multimorbidity research typically focuses on chronic and common diseases in patient and/or older populations. We propose a multidimensional multimorbidity score (MDMS) which incorporates chronic conditions, symptoms, and health behaviors for use in younger, presumably healthier, working populations.
  
  
  METHODS
  Cross-sectional study of 372,370 Spanish workers who underwent a standardized medical evaluation in 2006. We computed a MDMS (range 0-100) based on the sex-specific results of a multicorrespondence analysis (MCA). We then used Cox regression models to assess the predictive validity of this MDMS on incident sickness absence (SA) episodes.
  
  
  RESULTS
  Two dimensions in the MCA explained about 80% of the variability in both sexes: (1) chronic cardiovascular conditions and health behaviors, and (2) pain symptoms, in addition to sleep disturbances in women. More men than women had at least one condition (40 vs 15%) and two or more (i.e., multimorbidity) (12 vs 2%). The MDMS among those with multimorbidity ranged from 16.8 (SD 2.4) to 51.7 (SD 9.9) in men and 18.5 (SD 5.8) to 43.8 (SD 7.8) in women. We found that the greater the number of health conditions, the higher the risk of SA. A higher MDMS was also a risk factor for incident SA, even after adjusting for prior SA and other covariates. In women, this trend was less evident.
  
  
  CONCLUSIONS
  A score incorporating chronic health conditions, behaviors, and symptoms provides a more holistic approach to multimorbidity and may be useful for defining health status in working populations and for predicting key occupational outcomes.
authors.affiliation: CISAL-Center for Research in Occupational Health, Universitat Pompeu Fabra, Av Dr Aiguader, 88, PRBB building, 1st floor, Barcelona, Spain. monica.ubalde@upf.edu.|CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain. monica.ubalde@upf.edu.|IMIM (Institut Hospital del Mar Medical Research Institute), Barcelona, Spain. monica.ubalde@upf.edu.
authors.forename: Monica
authors.identifier: http://orcid.org/0000-0002-2037-6377
authors.initials: M
authors.lastname: Ubalde-Lopez
authors.affiliation: CISAL-Center for Research in Occupational Health, Universitat Pompeu Fabra, Av Dr Aiguader, 88, PRBB building, 1st floor, Barcelona, Spain.|CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain.|IMIM (Institut Hospital del Mar Medical Research Institute), Barcelona, Spain.|Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, Houston, TX, USA.
authors.forename: George L
authors.initials: GL
authors.lastname: Delclos
authors.affiliation: CISAL-Center for Research in Occupational Health, Universitat Pompeu Fabra, Av Dr Aiguader, 88, PRBB building, 1st floor, Barcelona, Spain.|CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain.|IMIM (Institut Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Benavides
authors.affiliation: Ibermutuamur (Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social 274), Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Calvo-Bonacho
authors.affiliation: CISAL-Center for Research in Occupational Health, Universitat Pompeu Fabra, Av Dr Aiguader, 88, PRBB building, 1st floor, Barcelona, Spain.|CIBERESP, CIBER in Epidemiology and Public Health, Madrid, Spain.|IMIM (Institut Hospital del Mar Medical Research Institute), Barcelona, Spain.|Southwest Center for Occupational and Environmental Health, Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas School of Public Health, San Antonio Campus, San Antonio, TX, USA.
authors.forename: David
authors.initials: D
authors.lastname: Gimeno
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006261:Headache / Q000453:epidemiology; D015438:Health Behavior; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology; D016272:Occupational Health; D010146:Pain / Q000453:epidemiology*; D015995:Prevalence; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D012893:Sleep Wake Disorders / Q000453:epidemiology*; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
keywords: Health conditions; Longitudinal; Occupational health; Sick leave