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Effort-Reward Imbalance at Work and Risk of Long-Term Sickness Absence in the Danish Workforce

Nielsen, Maj Britt D. PhD; Madsen, Ida E.H. PhD; Bültmann, Ute PhD; Aust, Birgit DrPH; Burr, Hermann PhD; Rugulies, Reiner PhD

Journal of Occupational and Environmental Medicine: April 2013 - Volume 55 - Issue 4 - p 454–459
doi: 10.1097/JOM.0b013e31827dba5b
Original Articles

Objective: To examine whether effort-reward imbalance (ERI) at work predicts onset of register-based long-term sickness absence (LTSA) in a representative sample of the Danish workforce.

Methods: We measured effort, reward, ERI, and covariates with self-administered questionnaires in a sample of 4775 employees. LTSA during 12-months of follow-up was assessed with a national register. We calculated hazard ratios (HRs) with Cox proportional hazard models.

Results: The HR of LTSA for a one-SD increase in ERI was 1.03 (95% confidence interval [CI], 0.93–1.15) in the most-adjusted model. For effort, the HR for a one-SD increase was 0.95 (95% CI, 0.85–1.06) and for reward the HR for a one-SD decrease was 1.14 (95% CI, 1.03–1.26).

Conclusions: ERI was not associated with onset of LTSA. Low reward, however, predicted LTSA.

From the National Research Centre for the Working Environment (Drs Nielsen, Madsen, Aust, and Rugulies), Copenhagen, Denmark; Department of Health Sciences, Community, and Occupational Medicine (Dr Bültmann), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Federal Institute for Occupational Safety and Health (BAuA) (Dr Burr), Berlin, Germany; and Departments of Public Health and Psychology (Dr Rugulies), University of Copenhagen, Denmark.

Address correspondence to: Maj Britt D. Nielsen, PhD, National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen, Denmark (

The study was funded by a grant of the Danish Working Environment Research Fund (grant 03-2008-09). The funding source had no further role in study design; in the collection, analysis, and interpretation of data; in the writing of the article; and in the decision to submit the article for publication.

The study has been notified to and registered by the Danish Data Protection Agency (Datatilsynet). According to Danish law, studies that include data from questionnaires and registers only do not need approval from the Danish National Committee on Biomedical Research Ethics (Den Centrale Videnskabsetiske Komité).

The authors declare that they have no conflict of interest.

©2013The American College of Occupational and Environmental Medicine