Academic journal article Scandinavian Journal of Work, Environment & Health

Work-Related Gender Differences in Physician-Certified Sick Leave: A Prospective Study of the General Working Population in Norway

Academic journal article Scandinavian Journal of Work, Environment & Health

Work-Related Gender Differences in Physician-Certified Sick Leave: A Prospective Study of the General Working Population in Norway

Article excerpt

Higher rates of female sick leave have been reported in Scandinavia (1-4) and other European countries (5). The gender-segregated labor market has been discussed as an important factor in observed gender differences in sick leave (6). According to official Norwegian statistics, approximately 80% of those employed in human health and social work sectors and activities are women, and >80% of those employed in construction and manufacturing sectors are men (7). Similar numbers have been reported in other Nordic countries (8, 9). However, only a few nationwide studies have been undertaken, and more knowledge is needed about the impact of specific risk factors in the workplace on gender differences in sick leave (10).

Gender differences in sick leave could be caused by differences in exposure to physical workloads (ie, mechanical exposure) and psychosocial factors in the workplace (11, 12). Men and women are typically involved in different types of jobs with divergent work environment characteristics; gender differences in exposure to psychosocial and physical risk factors exist, even when accounting for differences in job titles (8, 13). Jobs held by men are generally more physically demanding (14), and this has been reported as a risk factor in several studies (15-18). However, many female jobs are also characterized by physically strenuous work tasks, such as those found in nursing (eg, manually moving patients), and women often perform tasks that require precision and are repetitive in nature (13). Gender differences may also be expected for a range of psychosocial factors in the workplace. Studies have shown there are gender differences in exposure to risk factors, such as those proposed in Karasek's much-studied Job Demand-Control-Support model (8, 13). In particular, women are found to report lower levels of job control than men (14). Furthermore, women are more often involved in emotionally demanding "people work" (eg, nurses, service workers, etc.), and female jobs are often characterized by relatively lower levels of job rewards, such as wages and career opportunities (2). Low job control (11), emotional demands (19, 20), and effort-reward imbalance (21) have been reported as risk factors for sick leave in prospective studies and may contribute to the excess risk of sick leave observed among women. Overall, however, it is unclear whether men or women have the least healthy jobs (14, 22).

During the last two decades, a few prospectively designed studies have examined whether differences pertaining to working conditions or occupational exposure can explain the excess risk of physician-certified sick leave among women. Laaksonen et al (23, 24) studied sick leave among municipal workers in the capital of Finland. In the first study, adjusting for self-reported exposure to physical work demands but not psychosocial working conditions explained a substantial part of the female excess in sick leave of both short and longer duration (adjusting for age and socioeconomic status). In the second study, which adjusted for occupation by means of fixed regression, 33-50% of the excess risk of different lengths of sick leave among women was explained by differences between occupations held by men and women. In a general working population study from Denmark, Labriola et al (10) found that adjusting for self-reported exposure to psychosocial working conditions but not physical work demands explained about one-third of the female excess in sick leave periods of ≥8 weeks (adjusted for age and family status and socioeconomic position). Three studies have been conducted on different populations in Norway. Mastekaasa et al (22, 25) studied gender differences in sick leave periods of ≥4 days duration among Norwegian civil servants and sick leave periods of >2 weeks in the general working population. Controlling for occupation by means of fixed regression explained approximately 40% of the excess risk among female civil servants (25), whereas controlling for occupation had the opposite effect in the general working population study and slightly increased the gender difference (22). …

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