title: Cumulative exposure to shift work and sickness absence: associations in a five-year historic cohort.
abstract: Exposure to shift work has been associated with negative health consequences, although the association between shift work and sickness absence remains unclear. The aim of this study is to investigate associations between cumulative exposure to shift work and sickness absence among ground staff employees of an airline company.
  
  
  
  This study used data from the MORE (Monitoring Occupational Health Risks in Employees) cohort, which is a 5-year historic cohort. The population of the present study consisted of 7562 ground staff employees. For each employee, work schedules and sickness absence days between 2005 and 2009 were obtained from company records. For the exposure to different shift schedule types and to the cumulative number of night shifts, the association with long-term sickness absence (>7 consecutive sickness absence days) and the number of sickness absence episodes during 2009, was calculated using logistic and Poisson regression analyses. Socio-demographic variables, work-related variables, job classification variables, and previous sickness absence days were regarded as confounders.
  
  
  
  After adjusting for previous sickness absence and job classification variables, only the group of employees that switched into working in a three-shift schedule, showed a significantly increased risk for long-term sickness absence (OR = 1.31, 95%CI 1.02-1.69). Night shift exposure was not significantly associated with long-term sickness absence. Exposure to shift work was negatively associated with more sickness absence episodes. Employees who were exposed to more than 46 night shifts also showed a lower risk for more sickness absence episodes. Subgroup analyses showed that single employees and employees without children had an increased risk for long-term sickness absence when exposed to a three-shift schedule, and when they had changed between shift schedule types.
  
  
  
  Cumulative exposure to shift work proved to be negatively associated with more sickness absence episodes, and was not associated with more long-term sickness absence, although selection bias could not be ruled out. Future research should explore the influence of household composition, and take into account both previous sickness absence and psychosocial and physical work factors to obtain a better estimation of the association between shift work and sickness absence.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|KLM Health Services, Schiphol Airport, Schiphol, The Netherlands.
authors.forename: Alwin
authors.initials: A
authors.lastname: van Drongelen
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, The Netherlands. crl.boot@vumc.nl.|Body@Work TNO VUmc, Research Center on Physical Activity, Work and Health, VU University Medical Center, Amsterdam, The Netherlands. crl.boot@vumc.nl.
authors.forename: Cécile R L
authors.initials: CR
authors.lastname: Boot
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|KLM Health Services, Schiphol Airport, Schiphol, The Netherlands.
authors.forename: Hynek
authors.initials: H
authors.lastname: Hlobil
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|Body@Work TNO VUmc, Research Center on Physical Activity, Work and Health, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, The Netherlands.|KLM Health Services, Schiphol Airport, Schiphol, The Netherlands.
authors.forename: Tjabe
authors.initials: T
authors.lastname: Smid
mesh_terms: D000041:Absenteeism; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D016272:Occupational Health / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D014940:Work Schedule Tolerance; D055815:Young Adult
keywords: Cohort studies; Sick leave; Work schedule tolerance