Explanations for gender differences in sickness absence: evidence from middle-aged municipal employees from Finland

Objectives:To examine gender differences in sickness absence spells of various lengths and to explain these differences by health status, working conditions and family-related factors.Methods:The study included 5470 female and 1464 male employees of the City of Helsinki surveyed at baseline in 2000–2. These survey data were linked to the employer’s sickness absence records until the end of 2005, providing a mean follow-up time of 3.9 years. Explanations for gender differences in self-certified (1–3 days) and medically confirmed absence spells of various lengths (4 days or more, more than 2 weeks, and more than 60 days) were examined using Poisson regression.Results:Women had 46% higher risk for self-certified sickness absence than men. In medically confirmed spells there was 34% female excess which gradually weakened with lengthening absence, and no differences were observed in spells longer than 60 days. Adjusting for physical functioning and self-reported diagnosed diseases clearly attenuated gender differences in sickness absence spells shorter than two weeks and fully explained them in longer absence spells. Physical work demands explained female excess in medically confirmed absence spells of all lengths, as did work fatigue in spells longer than two weeks. Psychosocial working conditions and family-related factors did not affect the gender differences. Physical health problems, physical work demands and work fatigue were somewhat more prevalent in women than in men, but their impact on sickness absence was similar in both genders.Conclusions:The overall gender differences in sickness absence are due to relatively short absence spells being more common among women. In longer sickness absence spells the female excess is mainly explained by heavier burden of ill-health and to a lesser extent by higher physical work demands among women. The authors found no support for greater vulnerability to health- and work-related problems among women as reasons for sickness absence.