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Low Workload as a Trigger of Sick Leave: Results From a Swedish Case-Crossover Study

Hultin, Hanna PhD; Möller, Jette PhD; Alexanderson, Kristina PhD; Johansson, Gun PhD; Lindholm, Christina PhD; Lundberg, Ingvar PhD; Hallqvist, Johan PhD

Journal of Occupational and Environmental Medicine: February 2012 - Volume 54 - Issue 2 - p 202–209
doi: 10.1097/JOM.0b013e31823fdf68
Original Articles

Objectives: To investigate if exposure to an unusually low workload when ill can trigger taking sick leave.

Methods: A case-crossover design was applied to 546 sick-leave spells obtained from a cohort of 1430 employees within six Swedish workplaces. New sick-leave spells were reported from the workplaces during 3 to 12 months follow-up. Exposure was assessed in structured participant interviews at sick leave. Case and control periods from the same individual were sampled according to the matched-pair and usual-frequency approaches. Results are presented as odds ratios with surrounding 95% confidence intervals.

Results: The odds ratio of sick leave on a day with an unusually low workload was 2.57 (confidence interval, 1.07–6.16).

Conclusions: Becoming ill on a day with a lower workload than usual can trigger the decision to take sick leave.

From the Department of Public Health Sciences, Division of Public Health Epidemiology (Drs Hultin, Möller, and Hallqvist) and Department of Clinical Neuroscience, Division of Insurance Medicine (Drs Alexanderson and Lindholm), Karolinska Institutet, Stockholm, Sweden; National Centre for Work and Rehabilitation, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden (Dr Johansson); Department of Medical Sciences, Division of Occupational and Environmental Medicine (Dr Lundberg) and Department of Public Health and Caring Sciences, Division of Preventive Medicine (Dr Hallqvist), Uppsala University, Uppsala, Sweden.

Address correspondence to: Hanna Hultin, PhD, Karolinska Institutet, Department of Public Health Sciences, Division of Public Health Epidemiology, Norrbacka 7th floor, SE-171 76 Stockholm, Sweden (

The authors declare no competing interests.

Copyright © 2012 by the American College of Occupational and Environmental Medicine