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Lost Productive Work Time Costs From Health Conditions in the United States: Results From the American Productivity Audit

Stewart, Walter F. PhD, MPH; Ricci, Judith A. ScD, MS; Chee, Elsbeth ScD; Morganstein, David MS

Journal of Occupational & Environmental Medicine: December 2003 - Volume 45 - Issue 12 - pp 1234-1246
CME Article #1

Learning Objectives:

* Recall the overall magnitude of lsot productive time (LPT) and its dollar cost as found in the American Productivity Audit, and the respective contributions of absenteeism and decreased producitivity at work.

* Be aware of how LPT varies with a number of demographic and workrelated factors.

* Compare the factors predisposing to LPT for personal and family-related reasons.

The American Productivity Audit (APA) is a telephone survey of a random sample of 28,902 U.S. workers designed to quantify the impact of health conditions on work. Lost productive time (LPT) was measured for personal and family health reasons and expressed in hours and dollars. Health-related LPT cost employers $225.8 billion/year ($1685/employee per year); 71% is explained by reduced performance at work. Personal health LPT was 30% higher in females and twice as high in smokers (≥1 pack/day) versus nonsmokers. Workers in high-demand, low-control jobs had the lowest average LPT/week versus the highest LPT for those in low-demand, high-control jobs. Family health-related work absence accounted for 6% of all health-related LPT. Health-related LPT costs are substantial but largely invisible to employers. Costs vary significantly by worker characteristics, suggesting that intervention needs vary by specific subgroups.

Anumber of studies have described the work impact of common conditions like migraine, 1–10 low back pain, 11,12 arthritis, 13,14 diabetes, 15,16 allergic rhinitis, 7,17–22 gastroesophageal reflux, 23–25 and depression. 7,12,26–30 Research on these and other individual health conditions in both population and specific workplace settings has advanced our understanding of the cost of health care relative to costs from the impact of health conditions on work. Considerably less research has focused on measuring the composite impact of all health conditions on work. Moreover, although a number of studies have assessed the impact of health conditions on absence, relatively few have estimated the cost from both absence and reduced performance or effectiveness at work. The latter could be particularly important, because evidence indicates a number of health conditions have a greater impact on reduced performance at work than on absence. 1–3,5,6,20,21,24,27,31,33,34

To gain a broader understanding of the impact of health conditions on the U.S. workforce, we launched the American Productivity Audit (APA). The goal of the APA is to describe variation in overall absence time and reduced performance time from health conditions and to project costs to the U.S. workforce. We were specifically interested in understanding how lost productive time and the associated costs varied by key demographic variables, because these factors are strongly related to the prevalence of common health conditions and, as such, should influence employer expectations. In addition, the influence of selected features of work was assessed on both the amount of productive work time lost and the manner in which it was lost (ie, absence time vs. presenteeism). Finally, lost productive time was assessed by smoking status and alcohol consumption, 2 important and common habits that influence general health status.

From the AdvancePCS Center for Work and Health, Hunt Valley, Maryland (Drs Stewart, Ricci, and Chee); Geisinger Health System, Danville, Pennsylvania (Dr Stewart); and Westat, Rockville, Maryland (Mr Morganstein).

Address correspondence to: Walter F. Stewart, PhD, MPH, Center for Health Research & Rural Advocacy, Geisinger Health System, 100 N Academy Ave., Danville, PA 17822-3030; E-mail:

Walter F. Stewart has no commercial interest related to this article.

©2003The American College of Occupational and Environmental Medicine