Isabel Torá-Rocamora1, José Miguel Martínez2, David Gimeno3, Constança Alberti4, Josefina Jardí4, Rafael Manzanera5, Fernando G Benavides2, George Delclos6. 1. Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Red de investigacion en servicios de salud en enfermedades cronicas (REDISSEC), Spain; Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain. Electronic address: isatr10279@gmal.com. 2. Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain. 3. Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain; Southwest Center for Occupational and Environmental Health, Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, San Antonio Campus. San Antonio, Texas, USA. 4. Institut Català d'Avaluacions Mèdiques i Sanitàries, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain. 5. Medical and Health Care Services Division. Mutual Midat Cyclops (MC MUTUAL). Barcelona, Spain. 6. Center for Research in Occupational Health (CiSAL), Department of Experimental and Health Sciences, Universitat Pompeu Fabra. Barcelona, Spain; CIBER in Epidemiology and Public Health, Barcelona, Spain; Southwest Center for Occupational and Environmental Health, Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas, USA.
Abstract
OBJECTIVE: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. METHODS: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. RESULTS: We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). CONCLUSIONS: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.
OBJECTIVE: To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. METHODS: All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. RESULTS: We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). CONCLUSIONS: County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.
Authors: Fernando G Benavides; Isabel Torá; José Miguel Martínez; Josefina Jardí; Rafael Manzanera; Constança Alberti; Jordi Delclós Journal: Gac Sanit Date: 2010-03-04 Impact factor: 2.139
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