Descriptive study of sickness absence in Spanish regions in 2018: database study.

OBJECTIVES: To provide a wide and thorough description of sickness absence (SA) in Spain, focussing on the different regions of the country and the main characteristics of SA.
METHODS: A study of the SA spells in Spain, managed by the medical units of the National Institute of Social Security in 2018. The geographical scope of this observational study is the regions (Autonomous Community). Incidence, prevalence, and average duration SA in employees and self-employed are described. The study also describes the differences between non-work-related SA and work-related SA. In age and sex variables, the incidence and the average duration are described. The average duration by Diagnostic Chapters (International Classification of Diseases, 10th Revision (ICD-10)) and the highest number of SA spells by occupational activity and diagnosis are analysed.
RESULTS: A total of 540 045 SA spells are analysed by non-work-related SA and 63 441 by work-related SA. The national average prevalence in non-work-related SA spells is 32.98/1000 among employed and 30.48/1000 among self-employed; in work-related SA spells, the prevalence is 3.99/1000. The national incidence in non-work-related SA spells is 24.8/1000 for employees and 9.51/1000 for self-employed workers; in work-related SA spells the incidence is 3.55/1000. The average duration is 58.67 days, with the longest duration being neoplasms and the shortest corresponding to infectious disease. The Community of Madrid shows the lowest prevalence, incidence and average duration in work-related SA. Influenza is the diagnosis that generates the largest number of SA spells. Activities of call centres and temporary employment agency activities are the occupations that have the highest number of SA spells.
CONCLUSIONS: The biggest differences are found in the incidence and average duration, between the non-work-related SA spells and work-related SA. If those characteristics of the SA in which a region is more in deficit are known, it will be possible to do better management of the SA. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

The greatest strength of this study is the broad representativeness of its data.

The data used are at a national level, which allows a great perspective of sickness absence (SA) in Spain.

In this study, it has not always been possible to compare the data between employed and self-employed workers.

It has not always been possible to distinguish in this study between non-work-related and work-related in all SA spells.

SA spells lasting less than 4 days has not been included in this study.

Introduction

Sickness absence (SA) is one of the benefits of Social Security, included in article 169 of the Consolidated Text of the General Law of Social Security, RDL 8/2015 of 30th October. It comprises benefits in kind (medical assistance) and monetary compensations (benefits for SA). In Spain, there is a distinction between non-work-related SA (common disease and non-occupational accident) and work-related SA (professional illness and occupational accident). The differences between one group and the other can be seen both in the economic amount of the benefits due to sick leave and in the social security contributions. To be entitled to this subsidy, there must be medical examination and SA is certified by the family practitioner from the State Health Services, in case of common disease and non-occupational accident. If it is caused by occupational accidents or professional illness, this sick leave is certified by physicians ascribed to Insurance Companies linked to the Social Security system. Maximum duration of sick leave is 365 days, which can be extended for another 180 days if recovery and return of the worker to workplace are expected at that time. If the duration of sickness benefits has expired and the person’s state of health has not improved enough to return to work, the worker may receive a disability pension. The maximum duration of SA benefits is similar to other countries nearby such as Germany, Belgium or Austria. However, there are considerable differences in all European Union countries in terms of the amount of the payment and the requirements for receiving these benefits.1

Concerning the rest of the countries of the Organisation for Economic Co-operation and Development (OECD), Spain is in an intermediate position regarding the SA days per worker/year. Mexico is in the highest position with 27.7 days, whereas Chile, in the lowest position, has 7.3 days. Spain has an average of 10.3 days, which is similar to the level of Austria and the Netherlands (10 days) (https://stats.oecd.org/index.aspx?queryid=30123).

Like most European countries, Spain’s public sickness insurance spending is a major component of its social security system.1 The total financial cost of SA in consolidated Social Security budgets for 2019 in Spain reached 11 554 711.16 €, which is 8.89% of the general Social Security budget.2 Besides, the importance of SA caused by disease or accident is not only determined by the social and financial costs that each State dedicates to it,3 but also by the resources that employers assign to it,4 as well as the productivity losses5 and the deterioration of these workers’ health.6 It has been reported that work absenteeism due to illness is, in itself, a risk factor to fall sick, new periods of SA, unemployment, permanent disability pension,6–8 social exclusion9 and death.10–12 Long SA periods generate both an early retirement from the job market, a slower salary increase and an impoverishment of household wealth.6–9

Spain is divided into 17 regions. In each region there are significant differences in education, economic situation, unemployment rate and public health system. By sex, the percentage of men and women is balanced. The number of women is slightly higher, although the number of working men is still higher. By age, the regions with the youngest population are mainly those on the Mediterranean coast and also Castile La Mancha, Extremadura and the Community of Madrid. The northwestern regions are more aged.

In 2017 the working population rate in Spain was 59.41%. The regions with the highest rates of active population were the Canary Islands, the Balearic Islands, the Community of Madrid and Catalonia and those with the lowest rates were the Cantabrian, Western and Central regions. Service sector was the majority of the workforce (76%) in the islands, the Community of Madrid and Andalusia. Industry was the predominant sector in Navarre, the Basque Country and La Rioja; construction in Castile La Mancha; and agriculture and farming in Murcia (http://uvadoc.uva.es/handle/10324/26416)

These factors affect the behaviour of SA and their management in very different ways. It is important to know the differences to act accordingly.

Despite its relevance to public policies, there are few studies at the national level that describe the current situation of such benefits in our country; to date, the studies found in the literature related to this topic describe it partially,13 in some provinces or specific areas,14 about some specific diseases15 or specific groups of workers.16 The used data are national, representing the whole of the workers in Spain. It is a comprehensive and representative study of the total of SA spells in our country in 2018.

The general objective of this study is to provide a wide description of SA in Spain, focussing on the different regions of the country and according to the main characteristics of SA and differences between regions.

The specific objectives would be the description of the incidence, prevalence and average duration of SA; the description of the average duration and incidence rate about age and sex, as well as the average duration of SA by Diagnostic Chapters following the International Classification of Diseases, 10th Revision (ICD-10). The main occupational activities in which there are more workers with SA spells and the main diseases that cause more SA spells.

Material and methods

This study is carried out using the statistical databases provided by the Spanish National Institute of Social Security (INSS), which are published on the website of this organisation (www.seg-social.es/wps/portal/wss/internet/EstadisticasPresupuestosEstudios/), and databases obtained from specific programmes used by the Medical Units.

The reference population is formed by all the workers in Spain covered by the Social Security system in the year 2018. The study excludes the SA cases of Civil workers of the State, Armed Forces personnel and workers of the General Judicial Benefit Society, whose control and management are not an object of study. SA spells with a duration of fewer than 4 days are not included, because they do not obtain economic benefits from the Social Security system in Spain. Our study does not include unemployed workers, because they do not receive SA benefits

In Spain, our system of social security is contributory. To this end, both the worker and the company contribute to the system every month a sum of money (contribution) so that the worker can obtain benefits in case of illness or accident. If the worker is self-employed, it is himself who makes these economic contributions exclusively for non-work-related SA. This self-employed person also can pay voluntarily an extra amount for work-related SA to obtain benefits if he or she has a professional illness or an occupational accident.

Our database does not distinguish between employed and self-employed workers in the case of work-related SA. However, in non-work-related SA such division is made (table 1)

Table 1

Prevalence, incidence and average duration of sickness absence in Spain (2018)

	Prevalence			Incidence			Average duration (days)
	Non-work-related SA		Work-related SA	Non-work-related SA		Work-related SA	Non-work-related SA		Work-related SA
	Employed	Self-employed		Employed	Self-employed		Employed	Self-employed
Andalusia	29.41	31.43	4.26	19.72	9.28	3.98	44.79	98.35	37.24
Aragon	32.52	30.48	3.94	25.95	11.15	3.39	36.47	75.45	41.45
Principality of Asturias	36	38.96	5.01	18.73	10.85	3.53	58.55	105.03	47.08
Balearic Islands	31.29	21.7	4.72	27.02	6.46	5.15	33.02	84.01	30.94
Canary Islands	40.45	26.45	3.85	25.23	7.96	3.51	48.53	100.87	38.17
Cantabria	39.77	38.68	4.84	23.38	10.92	3.18	51.39	108.36	50.14
Castile and Leon	32.68	31.71	4.35	19.46	9.15	3.44	47.95	95.36	42.07
Castile La Mancha	32.4	35.57	4.48	19.91	9.93	3.96	46.02	98.54	38.08
Catalonia	35.14	28.76	3.8	36.37	10.17	3.6	28.54	83.48	36.06
Extremadura	31.59	38.9	4.64	12.76	8.94	3.68	67.53	112.86	41.42
Galicia	39.79	44.29	5.51	18.52	10.54	3.57	61.39	111.82	49.83
Community of Madrid	29.17	20.79	2.73	25.54	7.71	2.89	33.89	77.75	33.11
Murcia	35.55	40.63	4.12	20.21	11.33	3.39	48.39	98.49	40.2
Chartered Community of Navarra	35.73	30.72	4.28	43.87	16.46	3.88	24.64	55.15	37.86
La Rioja	27.3	25.65	4.41	25.28	10.91	3.91	34.53	69.95	38.87
Valencia	30.68	29.28	4.4	18.06	8.79	3.34	49.29	96.3	42.34
Basque Country	39.58	28.3	3.84	31.15	10.52	3.96	38.16	79.6	36.55
National total	32.98	30.48	3.99	24.98	9.51	3.55	38.81	91.38	38.23

SA, sickness absence.

Sample: The 2018 total SA records of the INSS is used, which coincide with the total population studied.

The variables used were: Age (in ranges), sex, average SA duration, diagnosis and diagnostic group (ICD-10), employee or self-employed, non-work-related SA (common disease non-occupational accident) or work-related SA (occupational accident and professional illness), and occupations with higher SA ranking according to the International Standard Industrial Classification of all Economic Activities (ISIC Rev-4).

The geographical scope of the study is the regions of Spain.

This is an observational study. The statistical calculations used to refer to all the people affiliated with the system who are entitled to receive the SA benefit (AFI), calculated according to the data provided by the Public Employment Service, the General Treasury of Social Security, INSS and the Social Institute of the Navy.

Incidence: The ratio that calculates the number of SA (MP2R) per 1000 affiliates. To compute the SA, the number of real registrations for the benefit (MP2R) is used. Monthly datum: MP2R×1000/AFI. Accumulated datum: average (MP2R)×1000/AFI.

Prevalence: The ratio that calculates the number of SA processes in force per 1000 affiliates. To compute the processes in force, the number of perceivers at the end of the period (MP4) is used. Monthly datum: MP4×1000/AFI. Accumulated datum: average (MP4)×1000/AFI.

The mean general duration is the average of all durations per year. The mean duration per age range and sex were calculated by dividing the number of days in SA by the number of workers in SA in that range. It is also described the number of workers in SA per 1000 affiliates. The median for the average duration per diagnostic chapter is calculated, using the statistics software Excel.

Patient and public involvement

Anonymised patient data are used in this study. Patients and members of the public are not involved in the conducting of the study.

Results

A total of 540 045 non-work-related SA spells and 63 441 work-related SA spells is analysed, which are those controlled by the Medical Units of the Spanish National Institute of Social Security. There is a total of 16 373 239 workers affiliated to social security.

The age of the study participants is 16 to 70 years old, both men and women. All are included in all the variables studied (non-work-related, work-related, employed, self-employed, sex, age, diagnosis and occupational activities). Follow-up time is 1 year (2018).

Our results are:

SA prevalence

The prevalence of non-work-related SA is 32.68/1000, among employed and 30.48/1000 among self-employed. Prevalence of work-related is 3.99/1000. In the non-work-related, it ranges between 27.3 in La Rioja and 40.45 in the Canary Islands in employed persons. In self-employed, it ranges between 21.5 in the Balearic Islands and 40.63 in the Region of Murcia. In work-related SA, it ranges from 2.73 in the Community of Madrid to 5.51 in Galicia (table 1).

SA incidence

Incidence of non-work-related was 24.87/1000 among employed and 9.51/1000 among self-employed. The incidence of work-related was 3.55/1000. Its values ranged between 12.76 in Extremadura and 36.7 in Catalonia (non-work-related, employed person); for self-employed it ranged between 7.71 in Community of Madrid and 16.46 in Chartered Community of Navarre (non-work-related SA). In work-related SA, it ranged from 2.89 in Madrid to 5.15 in the Balearic Islands (table 1).

Average SA duration

The average duration of SA was 58.67 days (in non-work-related SA from 38.81 days among employed to 91.38 days among self-employed) with a median of 48.53 days. In non-work-related SA for employees, it ranged between 24.64 days in Chartered Community of Navarre to 67.53 in Extremadura. For self-employed, it varied between 55.15 days in Navarra to 112.86 days in Extremadura. In work-related SA, it ranged from 30.94 days in the Balearic Islands to 50.14 in Cantabria (table 1).

SA spells and average duration (age ranges and sex)

In table 2, the total number of workers on sick leave by age and sex is analysed. There is a distinction between the absolute number of workers on SA and the number of workers on SA per 1000 affiliated per age group and gender because in Spain, in almost all age groups there are more men than women affiliated to social security. This may result in more absolute numbers of sickness absence for men, although the number of SA is higher for women according to the number of affiliates.

Table 2

Sickness absence (SA) and average duration (days), by age and sex

		Andalusia		Aragon		Principality of Asturias		Balearic Islands		Canary islands		Cantabria		Castile and Leon		Castile La Mancha		Catalonia		Extremadura		Galicia		Community of Madrid		Region of Murcia		CharteredCommunity of Navarre		La Rioja		Valencia		Basque Country
		Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man	Woman	Man
	Total workforce	28 519	30 319	7211	9576	1836	2100	11 010	10 470	11 404	9813	2235	2292	6859	9934	7294	10 106	92 204	83 921	2064	2793	6082	7549	43 592	42 510	5649	7818	5488	7886	1457	2034	15 154	18 327	8401	12 209
	Average affiliated workers	68 552.40	89 788.42	12 715.03	17 792.34	5368.35	6294.17	16 392.26	19 260.69	19 549.26	23 478.52	3792.28	4565.60	16 025.01	22 400.00	13 405.17	21 951.23	112 945.81	122 308.48	7057.99	11 732.44	17 279.67	21 582.01	81 635.82	97 705.09	13 971.74	19 847.78	6659.14	8653.16	2699.60	2696.28	46 147.56	56 875.39	17 735.00	22 613.08
16–25	SA/1000 affiliates	34.67	28.14	47.26	44.85	28.5	27.8	55.97	45.29	48.61	34.82	49.11	41.83	35.67	36.96	45.34	38.36	68.02	57.17	24.37	19.83	29.33	29.14	44.5	36.25	33.69	32.82	68.67	75.94	44.97	45.85	27.36	26.85	39.47	44.99
	Total days of SA	834 572	846 610	131 509	167 205	50 471	56 482	185 291	178 221	309 354	231 868	48 036	48 391	167 468	222 267	309 354	242 410	1 358 613	1 249 511	94 375	105 025	231 248	264 978	659 008	707 760	189 971	225 126	70 415	105 159	26 249	38 326	434 028	500 328	170 994	232 766
	Average duration	29	27	18	17	27	26	16	17	27	23	21	21	24	22	42	23	14	14	45	37	38	35	15	16	33	28	12	13	18	18	28	27	20	19
	Total workforce	100 686	86 518	20 411	20 921	7876	8438	22 333	19 262	32 182	25 520	7126	6214	23 829	23 851	22 958	23 179	195 844	166 163	8168	6905	25 440	23 811	126 980	102 745	19 347	18 506	5488	7886	1457	2034	15 154	18 327	8401	12 209
	Average affiliated workers	300 358.69	330 969.33	48 943.45	55 044.50	29 131.98	30 748.08	51 679.23	54 743.11	80 321.79	82 314.91	18 686.80	19 468.05	73 916.47	83 188.54	59 795.11	75 578.35	310 001.82	347 500.15	36 076.74	41 472.33	88 778.42	92 930.24	334 003.39	351 427.98	53 485.35	64 162.37	23 761.08	27 464.21	11 184.28	11 558.26	169 672.13	189 654.50	72 276.88	83 898.41
26–35	SA/1000 affiliates	27.93	21.78	34.75	31.67	22.53	22.87	36.01	29.32	33.39	25.84	31.78	26.60	26.86	23.89	32.00	25.55	52.65	39.85	18.87	13.87	23.88	21.35	31.68	24.36	30.14	24.04	52.48	51.62	33.13	36.82	24.45	19.81	37.83	34.70
	Total days of SA	4 002 601	2 741 036	613 970	475 288	326 129	321 994	596 265	434 597	1 290 175	833 828	282 294	203 621	918 856	733 947	927 034	686 484	4 915 171	3 405 555	475 765	307 251	1 289 570	1 018 756	3 636 681	2 344 947	882 767	621 458	325 739	275 255	127 536	108 671	2 207 518	1 512 322	1 228 249	847 290
	Average duration	39	31	30	22	41	38	26	22	40	32	39	32	38	30	40	29	25	20	58	44	50	42	28	22	45	33	21	16	28	21	44	33	35	24
	Total workforce	118 614	117 512	25 565	26 492	13 494	14 020	23 709	22 637	40 199	35 601	10 016	9757	31 594	32 035	26 742	29 050	221 680	205 633	9621	9250	38 674	35 964	151 187	125 041	23 103	24 813	20 685	22 630	5864	6555	63 233	65 615	51 452	55 641
	Average affiliated workers	416 547.17	493 349.53	73 820.89	88 587.25	53 033.04	57 508.87	72 634.45	79 189.07	113 319.60	124 332.39	31 436.56	34 354.87	116 512.04	134 105.28	85 921.38	117 415.38	467 172.39	536 140.86	51 846.68	57 864.40	154 779.30	159 073.44	448 746.41	492 003.79	74 900.72	103 493.33	37 428.06	44 884.12	18 530.51	19 654.64	256 013.07	308 714.88	131 005.73	147 561.07
36–45	SA/1000 affiliates	23.73	19.85	28.86	24.92	21.20	20.32	27.20	23.82	29.56	23.86	26.55	23.67	22.60	19.91	25.94	20.62	39.54	31.96	15.46	13.32	20.82	18.84	28.08	21.18	25.70	19.98	46.06	42.02	26.37	27.79	20.58	17.71	32.73	31.42
	Total days of SA	5 485 098	4 853 604	1 017 787	884 342	729 537	710 147	871 595	690 262	1 994 219	1 537 765	522 327	427 368	1 601 141	1 341 221	1 320 806	1 180 792	7 299 940	5 952 905	684 002	523 399	2 405 243	1 925 240	5 625 202	4 022 176	1 271 496	1 132 594	584 891	515 533	216 891	196 201	3 345 778	2 905 621	2 137 768	1 898 819
	Average duration	46	41	39	33	54	50	36	30	49	43	52	43	50	41	49	40	32	28	71	56	62	53	37	32	55	45	28	22	36	29	52	44	41	34
	Total workforce	93 419	97 446	20 531	21 134	12 107	11 379	19 560	18 340	33 484	32 340	7739	7993	27 137	28 786	20 740	24 528	161 373	145 283	9133	9654	32 304	30 656	116 428	97 152	17 870	19 928	17 679	17 432	4652	5523	52 477	56 490	44 669	47 083
	Average affiliated workers	376 667.85	452 781.53	72 642.41	86 832.17	50 430.1	54 182.72	59 519.62	70 647.25	103 329.08	124 900.1	27 966.17	32 274.09	121 691.32	144 244.47	78 676.23	113 500.26	420 095.39	483 766.12	48 959.11	61 304.89	155 675.61	146 483	392 653.45	435 113.09	63 760.45	88 653.91	36 669.67	43 790.26	16 865.87	19 151.91	227 708.97	286 020.66	132 334.79	149 918.57
46–55	SA/1000 affiliates	20.67	17.93	23.55	20.28	20.01	17.50	27.39	21.63	27.00	21.58	23.06	20.64	18.58	16.63	21.97	18.01	32.01	25.03	15.55	13.12	17.29	17.44	24.71	18.61	23.36	18.73	40.18	33.17	22.99	24.03	19.20	16.46	28.13	26.17
	Total days of SA	5 669 205	5 761 219	1 161 473	1 064 204	892 531	800 712	986 970	817 858	2 095 638	1 869 968	514 677	492 931	1 843 156	1 685 686	1 339 820	1 442 138	7 170 290	6 146 120	756 791	756 088	2 592 300	2 196 003	5 597 323	4 348 939	1 266 827	1 234 944	690 509	631 366	226 762	248 332	3 621 543	3 415 316	2 402 084	2 300 411
	Average duration	60	59	56	50	73	70	50	44	62	57	66	61	67	58	64	58	44	42	82	78	80	71	48	44	70	61	39	36	48	44	69	60	53	48
	Total workforce	54 794	55 337	13 132	12 022	9140	7504	11 512	9850	16 303	15 530	5491	5206	18 430	19 782	11 693	14 709	85 972	74 294	6060	6574	22 907	19 711	67 732	53 708	11 580	11 798	9312	8423	2931	3133	33 820	33 628	28 812	26 181
	Average affiliated workers	225 629.08	261 355.04	45 478.18	56 875.03	34 528.21	37 293.19	34 180.32	40 291.24	48 415.01	64 110.82	18 313.97	22 216.8	81 337.65	106 472.69	44 685.46	72 066.5	237 960.81	279 504.05	30 888.53	42 159.4	87 344.91	92 663.59	217 723.25	240 497.55	35 155.93	48 115.93	21 505.51	26 507.11	10 467.84	13 056.28	128 808.03	166 094.89	82 120.99	95 280.63
56–65	SA/1000 affiliates	20.24	17.64	24.06	17.61	22.06	16.77	28.07	20.37	28.06	20.19	24.99	19.53	18.88	15.48	21.81	17.01	30.11	22.15	16.35	12.99	21.85	17.73	25.93	18.61	27.45	20.43	36.08	26.48	23.33	20.00	21.88	16.87	29.24	22.90
	Total days of SA	4 016 323	4 392 212	954 029	886 164	799 503	654 003	722 340	644 055	1 270 661	1 239 034	458 470	446 106	1 611 454	1 563 351	971 777	1 205 977	5 269 955	4 690 436	567 570	631 405	2 297 445	1 810 405	4 144 067	3 305 759	1 026 123	969 808	478 852	457 600	200 637	200 286	2 884 959	2 773 183	2 023 474	1 882 291
	Average duration	73	79	72	73	87	87	62	65	77	79	83	85	87	79	83	81	61	63	95	96	100	91	61	61	88	82	51	54	68	63	85	82	70	71
	Total workforce	1009	912	218	229	143	135	248	248	405	507	93	90	309	369	222	243	1499	1783	109	118	496	416	1427	1472	209	205	97	99	48	53	565	586	395	395
	Average affiliated workers	11 950.42	13 802.04	2562.05	3147.87	2035.13	1864.38	2749.35	3794.28	3761	6238.89	1063.87	1151.9	4800.68	6608.46	2729.33	3896.45	16 654.52	21595.24	1635.76	2118.84	6019.34	6010.7	14 815.19	17 812.54	2137.48	2850.03	976.63	1251.16	558.86	884.86	7419.14	9562.67	3943.04	4299.16
>65	SA/1000 affiliates	7.04	5.51	7.09	6.06	5.86	6.03	7.52	5.45	8.97	6.77	7.28	6.51	5.36	4.65	6.78	5.20	7.50	6.88	5.55	4.64	6.87	5.77	8.03	6.89	8.15	5.99	8.28	6.59	7.16	4.99	6.35	5.11	8.35	7.66
	Total days of SA	102 994	86 720	22 938	20 767	14 254	15 093	19 474	21 387	42 070	54 105	9941	8986	33 554	36 135	30 606	23 582	137 904	164 426	14 652	13 172	60 119	49 220	115 468	116 354	28 423	19 951	7095	8826	5266	4674	63 313	59 850	38 371	34 999
	Average duration	102	95	105	90	99	111	78	86	103	106	106	99	108	97	137	97	91	92	134	111	121	118	80	79	135	97	73	89	109	88	112	102	97	88

SA, sickness absence.

Therefore, the total number of workers in SA by age and sex is higher in men than in women (table 2). According to age range and sex, the number of affiliates in SA is higher in women, except in Castilla and Leon, Chartered Community of Navarre and the Basque Country between 16 and 25 years of age, Principality of Asturias and La Rioja between 26 and 35 years and La Rioja in 36 to 45 and 46 to 55 years.

The average duration of SA is also higher in women than in men in all the age ranges, except in the Community of Madrid and La Rioja for 16 to 25 years, and Principality of Asturias, Balearic Islands, Canary Islands, Catalonia and Chartered Community of Navarre in workers over 65 years of age.

In women, the average duration of SA is 58.5 days (minimum 12 and maximum 137), with a median of 52 days. In men, the average is 53.08 days (minimum 13 and maximum 118), with a median of 44.

Average SA duration (diagnostic chapter)

The average SA duration, in general, is 56.82 days, with a median of 52.80 days. In all the regions Communities, the longest duration corresponds to neoplasms, followed by heart diseases and mental disorders. The shortest duration corresponds to infectious diseases (table 3).

Table 3

Average duration (days) by diagnostic chapter (ICD-10)

Diagnosis chapter (1)	Andalusia	Aragon	Principality of Asturias	Balearic Islands	Canary Islands	Cantabria	Castile and leon	CASTILE Castile la Mancha	Catalonia	Extremadura	Galicia	Community of Madrid	Region of Murcia	CharteredCommunity of Navarre	La Rioja	Valencia	Basque country	Average duration (DAYS)
(I) Certain infectious and parasitic diseases	14.91	7.87	9.33	5.50	9.13	6.40	14.69	14.89	5.09	16.92	17.39	6.58	8.03	3.87	4.69	9.50	9.19	9.65
(II) Neoplasms	109.78	120.16	131.05	123.93	102.69	113.30	124.41	131.66	99.47	136.05	134.20	87.92	109.89	105.09	104.53	121.97	142.86	117.59
(III) Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism	91.98	97.53	76.71	61.03	83.72	57.30	76.59	83.38	63.33	121.10	94.43	63.74	89.23	40.54	58.16	85.98	108.07	79.58
(IV) Endocrine, nutritional and metabolic diseases	72.54	67.72	66.06	50.60	64.70	81.62	57.53	72.88	59.03	78.47	88.73	56.96	81.66	43.03	48.54	71.53	81.06	67.22
(V) Mental and behavioural disorders	95.17	90.37	99.28	56.11	83.26	111.34	95.30	94.54	72.03	114.42	110.52	78.88	111.86	65.66	70.64	98.46	116.66	92.03
(VI) Diseases of the nervous system	79.81	61.81	85.12	49.46	70.50	65.51	78.55	74.37	44.98	80.11	95.84	54.49	78.03	26.40	44.64	79.21	70.51	67.02
(VII) Diseases of the eye and adnexa	44.13	42.99	47.85	28.72	40.94	45.41	45.05	44.12	29.17	56.76	48.63	29.62	46.43	18.80	29.77	41.70	45.77	40.35
(VIII) Diseases of the ear and mastoid process	33.04	26.90	33.55	18.33	31.33	29.05	27.30	26.82	18.89	47.66	42.55	21.63	35.98	13.85	18.54	29.13	37.40	28.94
(IX) Diseases of the circulatory system	103.40	107.05	102.25	85.73	90.19	108.21	99.35	104.24	79.86	106.57	111.53	76.86	112.64	80.66	90.12	101.52	119.39	98.8
(X) Diseases of the respiratory system	11.98	10.67	14.22	9.05	12.46	11.07	13.02	13.47	8.27	19.76	16.42	9.70	12.34	6.40	7.68	11.87	17.11	12.09
(XI) Diseases of the digestive system	30.65	35.44	44.16	28.59	39.97	43.95	21.86	35.59	27.19	50.51	47.53	32.56	41.01	14.97	30.98	40.84	37.32	35.48
(XII) Diseases of the skin and subcutaneous tissue	36.37	29.84	46.22	24.18	35.30	42.96	37.86	37.34	25.36	39.37	47.80	28.91	39.30	20.61	27.26	33.74	51.91	35.55
(XIII) Diseases of the musculoskeletal system and connective tissue	70.24	66.93	79.55	50.35	65.45	75.67	70.00	71.17	54.13	85.89	85.54	56.26	73.79	43.11	52.76	71.05	92.61	68.5
(XIV) Diseases of the genitourinary system	40.71	31.78	44.27	25.30	35.36	34.11	35.01	33.76	27.97	46.14	45.16	31.83	43.51	15.56	32.25	37.08	52.86	36.04
(XV) Pregnancy, childbirth and the puerperium	76.91	53.45	51.51	53.46	81.32	61.09	59.29	72.56	63.73	70.08	68.09	51.74	73.30	60.24	57.10	73.43	67.00	64.37
(XVII) Congenital malformations, deformations and chromosomal abnormalities	86.30	69.19	56.00	73.00	86.22	121.65	80.30	107.03	61.09	94.00	99.25	41.00	75.00	50.00	37.76	71.33	90.33	81.25
(XVIII) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified	36.13	29.88	38.00	23.00	26.00	42.50	33.23	36.11	20.82	38.50	37.25	28.00	51.00	9.00	28.45	31.67	37.67	32.19
(XIX) Injury, poisoning and certain other consequences of external causes	59.88	59.12	72.00	45.00	59.00	69.17	66.63	52.48	53.12	70.00	71.75	55.00	65.00	45.00	53.45	58.67	81.00	60.96

*Chapters XX, XXI and XXII are not included because the number of cases is not significant.

ICD-10, International Classification of Diseases, 10th Revision.

SA spells by ICD-10 diagnosis

Table 4 describes the main diagnoses that generate the highest numbers of SA spells/1000 affiliates/per month. The diagnoses with the highest number of SA were: Influenza, virus not identified, lower back pain and non-infective gastroenteritis and colitis, unspecified. They highlighted the multiple SA spells per non-infective gastroenteritis and colitis diagnosis, unspecific on Catalonia, Balearic Islands and Community of Navarre.

Table 4

Sickness absence spells by diagnosis (ICD-10)

Autonomous community of Spain	Code	Diagnosis	SA /1000 affiliates/per month
Andalusia	M54.5	Low back pain	1.36
	K52	Other non-infective gastroenteritis and colitis	1.00
	J00	Acute nasopharyngitis (common cold)	0.83
	J11	Influenza, virus not identified	0.82
	M54.2	Cervicalgia	0.57
	M54.3	Sciatica	0.52
	J02.9	Acute pharyngitis, unspecified	0.40
	J03.9	Acute tonsillitis, unspecified	0.38
Aragon	K52.9	Non-infective gastroenteritis and colitis, unspecified	1.94
	J11	Influenza, virus not identified	1.28
	M54.5	Low back pain	1.16
	J02.9	Acute pharyngitis, unspecified	0.97
	M25	Other joint disorders, not elsewhere classified	0.76
	M54.3	Sciatica	0.42
	M54.2	Cervicalgia	0.41
	F41	Other anxiety disorders	0.38
Principality of Asturias	K52.9	Non-infective gastroenteritis and colitis, unspecified	1.03
	M54.5	Low back pain	0.83
	F41	Other anxiety disorders	0.80
	J11	Influenza, virus not identified	0.55
	M54.3	Sciatica	0.46
	M54.2	Cervicalgia	0.40
	J02.9	Acute pharyngitis, unspecified	0.30
	M23	Internal derangement of knee	0.29
Balearic Islands	K52.9	Non-infective gastroenteritis and colitis, unspecified	2.29
	M54.5	Low back pain	1.61
	B97.8	Other viral agents as the cause of diseases classified to other chapters	1.26
	J11	Influenza, virus not identified	1.15
	F41.9	Anxiety disorder, unspecified	0.77
	J03.9	Acute tonsillitis, unspecified	0.72
	J00	Acute nasopharyngitis (common cold)	0.60
	M54.3	Sciatica	0.60
Canary Islands	M54.5	Low back pain	1.40
	J11	Influenza, virus not identified	1.16
	K52.9	Non-infective gastroenteritis and colitis, unspecified	1.02
	J00	Acute nasopharyngitis (common cold)	0.82
	J20.9	Acute bronchitis, unspecified	0.59
	F06.4	Organic anxiety disorder	0.57
	M54.3	Sciatica	0.51
	M54.2	Cervicalgia	0.44
Cantabria	K52.9	Non-infective gastroenteritis and colitis, unspecified	1.64
	J11	Influenza, virus not identified	1.13
	M54.5	Low back pain	0.98
	R45	Symptoms and signs involving emotional state	0.69
	J02.9	Acute pharyngitis, unspecified	0.67
	J06	Acute upper respiratory infections of multiple and unspecified sites	0.66
	M54.3	Sciatica	0.61
	M54.2	Cervicalgia	0.57
Castile and Leon	M54.5	Low back pain	1.28
	J11	Influenza, virus not identified	0.86
	F41.9	Anxiety disorder, unspecified	0.53
	M54.3	Sciatica	0.52
	J98.8	Other specified respiratory disorders	0.40
	J06.9	Acute upper respiratory infection, unspecified	0.37
	J00	Acute nasopharyngitis (common cold)	0.30
	K52	Other non-infective gastroenteritis and colitis	0.10
Castile La Mancha	M54.5	Low back pain	1.22
	K52.9	Non-infective gastroenteritis and colitis, unspecified	0.79
	J00	Acute nasopharyngitis (common cold)	0.62
	J11	Influenza, virus not identified	0.53
	K52	Other non-infective gastroenteritis and colitis	0.50
	J03.9	Acute tonsillitis, unspecified	0.43
	M54.2	Cervicalgia	0.39
	M54.3	Sciatica	0.37
Catalonia	K52.9	Non-infective gastroenteritis and colitis, unspecified	2.82
	J00	Acute nasopharyngitis (common cold)	2.09
	M54.5	Low back pain	1.96
	J11	Influenza, virus not identified	1.58
	F41.9	Anxiety disorder, unspecified	1.40
	B97.8	Other viral agents as the cause of diseases classified to other chapters	1.05
	J03.9	Acute tonsillitis, unspecified	0.85
	M54.2	Cervicalgia	0.68
Extremadura	M54.5	Low back pain	0.76
	J11	Influenza, virus not identified	0.49
	S93	Dislocation, sprain and strain of joints and ligaments at ankle and foot level	0.28
	M54.2	Cervicalgia	0.23
	M54.3	Sciatica	0.20
	F41	Other anxiety disorders	0.18
	M54.9	Dorsalgia, unspecified	0.17
	M75	Shoulder lesions	0.14
Galicia	M54.5	Low back pain	1.19
	J11	Influenza, virus not identified	0.94
	M54.2	Cervicalgia	0.47
	F41	Other anxiety disorders	0.44
	J20.9	Acute bronchitis, unspecified	0.42
	M54.3	Sciatica	0.30
	J03.9	Acute tonsillitis, unspecified	0.28
	S93	Dislocation, sprain and strain of joints and ligaments at ankle and foot level	0.24
Community of Madrid	K52.9	Non-infective gastroenteritis and colitis, unspecified	1.51
	M54.5	Low back pain	0.90
	F41	Other anxiety disorders	0.76
	J02.9	Acute pharyngitis, unspecified	0.67
	J11	Influenza, virus not identified	0.53
	M25	Other joint disorders, not elsewhere classified	0.48
	M54.3	Sciatica	0.45
	J06.9	Acute upper respiratory infection, unspecified	0.43
Region of Murcia	K52.9	Non-infective gastroenteritis and colitis, unspecified	1.21
	J11	Influenza, virus not identified	1.16
	M54.5	Low back pain	1.13
	J02.9	Acute pharyngitis, unspecified	0.82
	M54.3	Sciatica	0.69
	R45	Symptoms and signs involving emotional state	0.62
	M54.2	Cervicalgia	0.55
	J06.9	Acute upper respiratory infection, unspecified	0.41
Chartered Community of Navarre	K52.9	Non-infective gastroenteritis and colitis, unspecified	3.08
	J11	Influenza, virus not identified	2.52
	M54.5	Low back pain	1.88
	J06.9	Acute upper respiratory infection, unspecified	1.62
	J00	Acute nasopharyngitis (common cold)	1.26
	A08.5	Ofter specified intestinal infections	0.98
	J20.9	Acute bronchitis, unspecified	0.95
	F41.9	Anxiety disorder, unspecified	0.89
La Rioja	K52.9	Non-infective gastroenteritis and colitis, unspecified	2.20
	J00	Acute nasopharyngitis (common cold)	1.42
	J11	Influenza, virus not identified	1.14
	M54.5	Low back pain	1.10
	M54.3	Sciatica	0.56
	J06.9	Acute upper respiratory infection, unspecified	0.39
	M25.5	Pain in joint	0.36
	R45.0	Nervousness	0.35
Valencia	M54.5	Low back pain	1.04
	J11	Influenza, virus not identified	0.85
	F41.9	Anxiety disorder, unspecified	0.56
	K52.9	Non-infective gastroenteritis and colitis, unspecified	0.55
	J00	Acute nasopharyngitis (common cold)	0.45
	M54.2	Cervicalgia	0.39
	M54.3	Sciatica	0.33
	J20.9	Acute bronchitis, unspecified	0.32
Basque Country	M54.5	Low back pain	1.83
	M54.2	Cervicalgia	1.68
	J00	Acute nasopharyngitis (common cold)	0.91
	K52.9	Non-infective gastroenteritis and colitis, unspecified	0.75
	J11	Influenza, virus not identified	0.63
	F43.2	Adjustment disorders	0.56
	F41.9	Anxiety disorder, unspecified	0.49
	R10	Abdominal and pelvic pain	0.35

ICD-10, International Classification of Diseases, 10th Revision; SA, sickness absence.

SA spells by ISIC Rev-4

There is an outstanding number of SA spell in general public administration activities, hospital activities, retail sale in non-specialised stores with food, beverages or tobacco predominating and general cleaning of buildings (table 5).

Table 5

Sickness absence situations by occupational activities (International Standard Industrial Classification of all Economic Activities, ISIC Rev-4)

Autonomouscommunity	Code	Occupational activities	SA spells	SA/1000 affiliates
Andalusia	8411	General public administration activities	61 457	30.84
	8610	Hospital activities	40 544	20.30
	8121	General cleaning of buildings	23 802	18.89
	5610	Restaurants and mobile food service activities	23 377	28.5
	5630	Beverage serving activities	20 659	10.74
	4100	Construction of buildings	16 608	10.22
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	16 253	9
	5510	Hotels and similar accommodation	16 061	20.05
	4630	Wholesale of food, beverage and tobacco	15 010	9.72
	8220	Activities of call centres	14 652	69.07
Aragon	8411	General public administration activities	9685	23.30
	8610	Hospital activities	8022	16.61
	7820	Temporary employment agency activities	7550	73.50
	2930	Manufacture of parts and accessories of motor vehicles	5874	11.70
	8121	General cleaning of buildings	5464	21.78
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	3773	5.3
	5610	Restaurants and mobile food service activities	3669	28.5
	8220	Activities of call centres	3459	43
	4923	Freight transport by road	3214	15.57
	5630	Beverage serving activities	3073	10.95
Principality of Asturias	8610	Hospital activities	6422	20.65
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	5217	9.56
	8411	General public administration activities	4000	19.21
	5630	Beverage serving activities	2560	10.46
	2410	Manufacture of basic iron and steel	2330	12.08
	8121	General cleaning of buildings	2285	13.6
	5610	Restaurants and mobile food service activities	2047	22.45
	8730	Residential care activities for the elderly and disabled	1950	20.82
	8122	Other building and industrial cleaning activities	1651	18
	9700	Activities of households as employers of domestic personnel	1365	8.51
Balearic Islands	5510	Hotels and similar accommodation	19 736	30.31
	5610	Restaurants and mobile food service activities	9399	13.6
	8610	Hospital activities	8059	26.49
	8411	General public administration activities	6141	27.19
	4100	Construction of buildings	6129	13
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	5078	8.44
	5630	Beverage serving activities	4740	8.32
	8121	General cleaning of buildings	4125	16.70
	5520	Short-term accommodation activities	3034	12.56
	4751	Retail sale of textiles in specialised stores	2408	21.6
Canary Islands	5510	Hotels and similar accommodation	26 147	43.13
	8610	Hospital activities	16 865	30.7
	8411	General public administration activities	15 899	31.59
	5610	Restaurants and mobile food service activities	11 628	18.32
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	10 495	7.9
	5520	Short-term accommodation activities	7221	32.30
	8121	General cleaning of buildings	7000	18.7
	5630	Beverage serving activities	5507	8.36
	4100	Construction of buildings	5414	11.70
	8521	General secondary education	5340	12.13
Cantabria	8411	General public administration activities	3851	28.5
	7820	Temporary employment agency activities	3612	76.53
	8610	Hospital activities	3492	20.09
	8121	General cleaning of buildings	1828	17.11
	5610	Restaurants and mobile food service activities	1616	22.5
	5630	Beverage serving activities	1383	10.97
	8220	Activities of call centres	1170	60
	8521	General secondary education	1170	8.38
	4791	Retail sale via mail order houses or via Internet	1023	16.8
	8620	Medical and dental practice activities	998	32
Castile and Leon	8411	General public administration activities	9940	16.89
	8610	Hospital activities	9741	12.04
	8220	Activities of call centres	8920	85.14
	8121	General cleaning of buildings	7489	17.87
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	5953	7.94
	8790	Other residential care activities	5089	21.95
	5630	Beverage serving activities	5023	14.59
	7820	Temporary employment agency activities	4676	45.75
	5610	Restaurants and mobile food service activities	4493	24.90
	2910	Manufacture of motor vehicles	4409	10.35
Castile La Mancha	8411	General public administration activities	15 003	22.17
	8610	Hospital activities	7820	14.89
	8121	General cleaning of buildings	5363	19.98
	7820	Temporary employment agency activities	5272	56.70
	5210	Warehousing and storage	5251	60
	4100	Construction of buildings	4479	8.94
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	4267	5.06
	5610	Restaurants and mobile food service activities	4092	32.54
	4923	Freight transport by road	3846	14.08
	5630	Beverage serving activities	3526	10.62
Catalonia	8610	Hospital activities	75 958	32.68
	8411	General public administration activities	70 569	32.11
	5610	Restaurants and mobile food service activities	45 084	47
	8121	General cleaning of buildings	44 117	22.8
	7820	Temporary employment agency activities	43 109	73.56
	8220	Activities of call centres	37 877	74.91
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	30 528	12.95
	4751	Retail sale of textiles in specialised stores	24 417	10.36
	8812	Social work activities without accommodation for the elderly and disabled	20 007	43.56
	8423	Public order and safety activities	19 807	65
Extremadura	8411	General public administration activities	10 813	23.68
	8610	Hospital activities	5921	17.95
	8121	General cleaning of buildings	2007	19.56
	8812	Social work activities without accommodation for the elderly and disabled	1643	18
	4100	Construction of buildings	1610	7.48
	5630	Beverage serving activities	1599	10.55
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	1136	3.98
	5610	Restaurants and mobile food service activities	1044	13.64
	4923	Freight transport by road	914	12.89
	0150	Mixed farming	902	8.79
Galicia	8610	Hospital activities	12 552	16.6
	8411	General public administration activities	12 137	19.12
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	7498	6.4
	5630	Beverage serving activities	6532	12
	8121	General cleaning of buildings	5775
	7820	Temporary employment agency activities	5270	40.61
	9700	Activities of households as employers of domestic personnel	4830	11.45
	5610	Restaurants and mobile food service activities	4664	17.6
	8220	Activities of call centres	4558	47.19
	4100	Construction of buildings	3622	5.27
Community of Madrid	8610	Hospital activities	44 482	17.65
	8121	General cleaning of buildings	42 703	20.63
	5610	Restaurants and mobile food service activities	36 939	28.54
	4711	General public administration activities	35 475	21.94
	8220	Activities of call centres	29 212	67.3
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	28 014	7.57
	9700	Activities of households as employers of domestic personnel	21 385	20.93
	8299	Other business support service activities n.e.c	20 351	13
	5630	Beverage serving activities	17 608	12.05
	4751	Retail sale of textiles in specialised stores	15 735	15.31
Region of Murcia	8620	Medical and dental practice activities	11 008	34.8
	0113	Growing of vegetables and melons, roots and tubers	7233	28.29
	7820	Temporary employment agency activities	6037	23.35
	4711	General public administration activities	6003	24.41
	8121	General cleaning of buildings	4915	25.01
	5610	Restaurants and mobile food service activities	3672	34.02
	5630	Beverage serving activities	3635	21.63
	4630	Wholesale of food, beverage and tobacco	3514	13.62
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	3228	8.96
	4923	Freight transport by road	2914	14.28
CharteredCommunity of Navarre	8610	Hospital activities	14 408	46.16
	8411	General public administration activities	7408	57.01
	2930	Manufacture of parts and accessories of motor vehicles	5782	18.2
	7820	Temporary employment agency activities	5558	94.19
	8521	General secondary education	3909	19.86
	8121	General cleaning of buildings	3520	31.17
	1030	Processing and preserving of fruit and vegetables	3256	38.37
	2910	Manufacture of motor vehicles	3195	17.07
	8812	Social work activities without accommodation for the elderly and disabled	3151	76.35
	9700	Activities of households as employers of domestic personnel	2382	23.71
La Rioja	8610	Hospital activities	1698	18.25
	8611	General public administration activities	1612	22.76
	1520	Manufacture of footwear	1463	38.2
	8121	General cleaning of buildings	1290	29.05
	1030	Processing and preserving of fruit and vegetables	1217	27.4
	7820	Temporary employment agency activities	1060	71.12
	2930	Manufacture of parts and accessories of motor vehicles	1006	12.1
	5630	Beverage serving activities	973	14.3
	1102	Manufacture of wines	962	13.09
	0113	Growing of vegetables and melons, roots and tubers	907	21.5
Valencia	8610	Hospital activities	24 063	21.57
	8611	General public administration activities	23 311	24.51
	5610	Restaurants and mobile food service activities	16 234	20.93
	8121	General cleaning of buildings	12.758	16.04
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	11 239	6.14
	4630	Wholesale of food, beverage and tobacco	7300	8.81
	5630	Beverage serving activities	8732	6.49
	4923	Freight transport by road	7300	11.49
	7820	Temporary employment agency activities	7126	29.24
	4100	Construction of buildings	6663	6.21
Basque Country	8610	Hospital activities	22 704	30.48
	8611	General public administration activities	15 565	27.16
	8121	General cleaning of buildings	13 043	29.20
	8521	General secondary education	12 519	14.51
	8812	Social work activities without accommodation for the elderly and disabled	8760	14.75
	5610	Restaurants and mobile food service activities	8419	29.01
	4711	Retail sale in non-specialised stores with food, beverages or tobacco predominating	6625	6.6
	9700	Activities of households as employers of domestic personnel	6284	18.55
	2591	Forging, pressing, stamping and roll-forming of metal; powder metallurgy	6086	10.29
	5630	Beverage serving activities	5842	18.02

SA, sickness absence.

However, when these cases are analysed by the number of affiliates in each occupational activities, those occupations in which the most SA spells is found are activities of call centres, temporary employment agency activities and general public administration activities.

Discussion

The obtained results confirm many of the findings described by other authors at both the national17 and international levels.18

The prevalence and incidence are much higher in non-work-related SA than in work-related SA, which is logical, since work-related SA only included the accidents occurred in the workplace, as well as the professional diseases described in the Royal Decree 1299/2006 of 10th November, and not all diseases, accidents and injuries that any worker can suffer from. Conversely, in the case of non-work-related SA all illness and accidents are included.

When the SA prevalence in each region is analysed, it is observed that there are few regions, such as Aragon and the Community of Madrid, below the national average. By breaking it down into non-work-related SA, the regions that are below the average were Andalusia, Aragon, the Balearic Island, Community of Madrid, La Rioja and Valencian Community, while in work-related SA, Aragon, Catalonia, the Basque Country, the Canary Islands and Community of Madrid stand out below the average. It is difficult to know the reasons for these differences in the prevalence SA. To analyse the possible causes of these differences, it would be necessary to carry out other sorts of studies.

There are also important differences concerning incidence, with these differences being very marked in some regions. Only Castile and Leon does not reach the national average. In the case of non-work-related SA, Andalusia, Castile and Leon, Extremadura and Valencian Community are below the national average. In work-related SA, values are very approximate in all regions. The highest value is in the Balearic Islands.

There is a significant difference in the incidence of SA between the employed and self-employed which was much higher in the former. This is in line with the results obtained in other studies conducted in Spain4 and at an international level.7 19 20 The self-employed are only charging for the work they have done. On the other hand, if they are in SA’s position, the amount they receive is lower, because it depends on their contributions to the social security system.

The average duration is shorter in all regions in the case of work-related SA because these SA are managed directly by associated insurance companies, whose network of doctors and hospital beds are exclusively for workers who had suffered occupational accidents or professional illness. In the case of non-work-related SA, healthcare is provided by the Public Health System, where other patients are also treated (children, elderly, non-working patients, and so on) and, therefore, waiting lists were longer and treatments for these patients could be delayed further. Besides, the longest duration is for oncological diseases and mental disorders, the origin of which is usually unrelated to work. This finding is in line with that of other studies at the national4 and European19 level. Non-work-related SA showed a longer duration to work-related SA which has remained like this for years.14 The region that showed the shortest duration as a whole is Navarre, where the health expenditure per inhabitant is also the highest in Spain. Healthcare expenditure is also higher in the Basque Country, however, the duration of the it is one of the longest in many diagnostic chapters.

The most noteworthy fact is that the number of days on SA for self-employed workers is twice as much as for employees in all of Spain’s regions. In our experience, this can be caused by the fact that self-employed workers do not usually start a process of short-term SA, because cash benefits for SA are paid 30 days after the start of SA and they do not receive cash benefits in short-term SA

The incidence, prevalence and average duration increase with age. This occurrs in all age ranges except for very young workers (men and women) and those over 65 years old. In young people it can be explained by the fact that they often have low-skilled jobs (they have not yet finished their education). They are often temporary and unstable jobs, and many young people work and study at the same time. This causes a double workload that could contribute to worsening their health. As it can be seen, they are short-term SA, which could indicate a low severity of the pathologies that produce them. In the over-65s the prevalence is very low in all regions. One possible explanation is that the retirement age in Spain is around 65 and the worker who decides to continue working instead of retiring is in good health. However, the duration of these SA is very long, because at this age there is a greater prevalence of serious pathologies (neoplasms, ictus, and so on).

The differences observed in the number of employees regarding sex are in line with the patterns obtained in other studies, with higher incidence19 and longer duration21 in women. There is a sex breach in some European countries (Spain, Ireland, France, Belgium and UK) compared with others (Netherlands, Portugal and Italy).21 22 The incidence increases with age, which is in agreement with most studies at the national4 23 and international7 18 21–24 level, with higher intensity according to the number of affiliates per sex and age range (table 2). Among the multiple explanations for this fact, it is worth highlighting the following: the double work women usually carry out, that is, paid work and domestic work, with greater responsibilities for the family (traditional gender role),22 24 the different behaviour of women toward disease,22 their greater morbidity related to maternity25 and more fragile health,26 as well as their lower commitment to work.22 Other authors highlight the occupational differences, which could explain more than half of the gender differences,24 as well as the stress level.24 However, this gender breach is not constant in the long-term in all the European countries;21 22 in fact, some studies question its existence based on the occupational level27 and the stress level.28

The longest duration by diagnostic chapter is oncological diseases, cardiovascular diseases and mental disorders, which is in line with other studies.29–31 Moreover, this fact poses a serious problem of public health, given the accelerated increase of chronic diseases in all the countries around Spain,32 with the consequent increase in the incidence and duration of SA and the cost that it implies.4 29

The diagnosis that generated the largest number of SA cases, after the influenza, is lower back pain. This finding is in line with numerous studies, being, nationally, the main diagnosis of sick leave due to its high incidence and recurrence rate,33 as well as the duration23 34 35 and economic costs of such SA.35 This is due to the great prevalence of such pathology, regardless of whether or not it generates SA cases,33 36 among other factors.

The Public Administration is in the first, second and third positions in the described ranking in almost all the regions. This can be explained by the difference between workers of the public sector, who represent a greater number of SA cases than employees in the private sector, as in other countries.19 37 38 However, in previous studies carried out in Spain, the Public Administration did not represent or occupied such an important place in SA spells, being greatly surpassed by the industrial and construction sectors.16 39

When the SA spells are analysed by the number of affiliated workers in each occupational activities, a higher number of them is found in workers in call centres and temporary employment agencies. These activities have a high level of job instability, with a high worker turnover and very short-term contracts.40 This could explain the high rate of absence in them.

One of the occupational activities with the highest number of SA spells is retail sale in non-specialised stores with food, beverages or tobacco predominating, but when it is analysed by the number of affiliates, this number of SA spells is one of the lowest of all occupational activitiess. One possible explanation is that many of these workers are self-employed and, as mentioned before, in these workers the SA incidence is very low.

Conclusion

This study shows the important characteristics of SA in Spain. The most important differences are found in SA incidence and average duration between the different regions and non-work-related and work-related SA spells. There are also important differences in the number of SA spells between different occupational activities.

The regions that show the most difference SA are the Chartered Community of Navarre and the Community of Madrid. It would be interesting to carry out further studies that analyse the main factors that influence SA in Spain.