The European Journal of Public Health Advance Access published online on October 20, 2009
The European Journal of Public Health, doi:10.1093/eurpub/ckp162
Interrelationships between education, occupational class, income and sickness absence
Kustaa Piha1, Mikko Laaksonen1, Pekka Martikainen2, Ossi Rahkonen1 and Eero Lahelma1
1 Department of Public Health, University of Helsinki, Helsinki, Finland
2 Population Research Unit, Department of Sociology, University of Helsinki, Helsinki, Finland
Correspondence: Kustaa Piha, MD, MSc(Soc), MSc(Econ), P.O. Box 41, FIN-00014, University of Helsinki, Helsinki, Finland, tel: +358 50 359 6835, fax: +358 9 348 9171, e-mail: kustaa.piha{at}helsinki.fi
Received April 14, 2009 , accepted September 17, 2009
Background: Socio-economic position measures, such as education, occupational class and income, are well-known determinants of health. However, previous studies have not paid attention to mutual interrelationships between these socio-economic position measures and medically confirmed sickness absence. Methods: The study is a register-based study. The participants were municipal employees of the City of Helsinki aged 25–59 years in 2003. There were 21 599 women and 5841 men participants. Three socio-economic position measures were used, namely three-level education, four-level occupational class and gross individual income quartiles. Main outcome measure was medically confirmed sickness absence spells of 4 days or longer. Inequality indices were calculated using Poisson regression analysis. Results: High education, occupational class and individual income were all consistently associated with lower sickness absence rates among both women and men. After mutual adjustment, education and occupational class remained independent determinants of sickness absence. The association of individual income with sickness absence was practically explained by temporally preceding education and occupational class. Conclusions: Our results indicate that education and occupational class—rather than income—are strong determinants of sickness absence. Education, occupational class and income are complementary socio-economic position measures. To better inform sickness absence policy, future studies should aim to establish whether the observed socio-economic differences reflect broader differences in ill-health, lifestyle and working conditions.
Keywords: sickness absence, socio-economic status, health inequality.