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Maria Melchior, ScD, Nancy Krieger, PhD, Ichiro Kawachi, MD, PhD, Lisa F. Berkman, PhD, Isabelle Niedhammer, PhD and Marcel Goldberg, MD, PhD

Maria Melchior, Isabelle Niedhammer, and Marcel Gold-berg are with the National Institute of Health and Medical Research, Saint-Maurice, France. Nancy Krieger, Ichiro Kawachi, and Lisa F. Berkman are with the Department of Society, Human Development and Health, Harvard School of Public Health, Boston, Mass.

Correspondence: Reprint requests should be sent to Maria Melchior, INSERM, U687-IFR69, HNSM, 14, rue du Val d’Osne, 94415 Saint-Maurice, France (e-mail: maria.melchior{at}st-maurice.inserm.fr).

Objectives. To estimate the contribution of stress-related and physical work factors to occupational class disparities in sickness absence from work.

Methods. Our sample consisted of 8847 men and 2886 women participating in the French GAZEL cohort study. Occupational class and medically certified sickness absence data (1995–2001) were obtained from the participants’ employer. Work characteristics (physical and stress-related) were self-reported. We calculated rate ratios with Poisson regression models; fractions of sickness absence attributable to work factors were estimated with the Miettinen formula.

Results. Sickness absence was distributed along an occupational gradient. Work characteristics accounted for 19% (women) and 21% (men) of all absences. Physical work conditions accounted for 42% and 13% of absences for musculoskeletal reasons, and work stress accounted for 48% and 40% of psychiatric absences. Overall, about 20% of the occupational class gradient in sickness absence could have been associated with deleterious work conditions.

Conclusion. Work conditions contribute to sickness absence, particularly among manual workers and clerks. Policies that decrease ergonomic constraints and work stress also could reduce the burden of ill health and sickness absence among the lowest strata of working populations.

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