title: Socioeconomic differences in health check-ups and medically certified sickness absence: a 10-year follow-up among middle-aged municipal employees in Finland.
abstract: There is contradictory evidence on the association between health check-ups and future morbidity. Among the general population, those with high socioeconomic position participate more often in health check-ups. The main aims of this study were to analyse if attendance to health check-ups are socioeconomically patterned and affect sickness absence over a 10-year follow-up.
  
  
  
  This register-based follow-up study included municipal employees of the City of Helsinki. 13 037 employees were invited to age-based health check-up during 2000-2002, with a 62% attendance rate. Education, occupational class and individual income were used to measure socioeconomic position. Medically certified sickness absence of 4 days or more was measured and controlled for at the baseline and used as an outcome over follow-up. The mean follow-up time was 7.5 years. Poisson regression was used.
  
  
  
  Men and employees with lower socioeconomic position participated more actively in health check-ups. Among women, non-attendance to health check-up predicted higher sickness absence during follow-up (relative risk =1.26, 95% CI 1.17 to 1.37) in the fully adjusted model. Health check-ups were not effective in reducing socioeconomic differences in sickness absence.
  
  
  
  Age-based health check-ups reduced subsequent sickness absence and should be promoted. Attendance to health check-ups should be as high as possible. Contextual factors need to be taken into account when applying the results in interventions in other settings.
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Kustaa
authors.initials: K
authors.lastname: Piha
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Hilla
authors.initials: H
authors.lastname: Sumanen
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Eero
authors.initials: E
authors.lastname: Lahelma
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: Ossi
authors.initials: O
authors.lastname: Rahkonen
mesh_terms: D000041:Absenteeism; D000328:Adult; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data*; D012737:Sex Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D017132:Workplace / Q000706:statistics & numerical data; D055815:Young Adult
keywords: HEALTH SERVICES; INEQUALITIES; OCCUPATIONAL HEALTH; SICKNESS ABSENCE