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Job Strain and Long-Term Sickness Absence From Work

A Ten-Year Prospective Study in German Working Population

Mutambudzi, Miriam, PhD; Theorell, Töres, MD, PhD; Li, Jian, MD, PhD

Journal of Occupational and Environmental Medicine: April 2019 - Volume 61 - Issue 4 - p 278–284
doi: 10.1097/JOM.0000000000001525

Objective: The aim of this study was to examine the prospective associations between baseline job strain and 10-year cumulative incidence of long-term sickness absence (LTSA) in the German workforce.

Methods: This study used longitudinal data from the 2001 to 2011 waves of The German Socio-Economic Panel (SOEP) (n = 9794). Kaplan–Meier survival curves and Cox proportional hazard regression models were used to examine the prospective association between job strain and incidence of LTSA.

Results: High strain [hazard ratio (HR) = 1.28, 95% confidence interval (95% CI) = 1.12 to 1.46] and passive jobs (HR = 1.14, 95% CI = 1.01 to 1.30) were significantly associated with LTSA after full adjustment for covariates, with greater risk in the older participants (>45) in passive (HR = 1.33, 95% CI = 1.08 to 1.63) and high strain (HR = 1.56, 95% CI = 1.27 to 1.92) jobs.

Conclusion: Jobs with low control over work were associated with LTSA in German workers. More studies using longitudinal employment data, and more detailed job strain measures are warranted.

Global Health Institute, Department of Epidemiology and Social Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (Dr Mutambudzi); Department of Preventive Medicine & Community Health, University of Texas Medical Branch, Galveston, Texas (Dr Mutambudzi); Stress Research Institute, Stockholm University, Stockholm, Sweden (Dr Theorell); Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Germany (Dr Li).

Address correspondence to: Miriam Mutambudzi, PhD, Global Health Institute, University of Antwerp, Doornstraat 33, 2610 Antwerpen, Belgium (; Dr Jian Li, MD, PhD, Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, University of Düsseldorf, Germany, Moorenstraße 5, 40225 Düsseldorf, Germany (

Clinical Significance: Our study found that jobs with low levels of control were associated with LTSA. Workplace interventions, or policy, may be needed to effectively enhance public health efforts, working conditions, and reduce lost productivity for employers.

Mutambudzi, Theorell, and Li have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2019 by the American College of Occupational and Environmental Medicine