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Mika Kivimäki, PhD, Jenny Head, MSc, Jane E. Ferrie, PhD, Harry Hemingway, MD, Martin J. Shipley, MSc, Jussi Vahtera, MD and Michael G. Marmot, FFPHM

Mika Kivimäki and Jussi Vahtera are with the Finnish Institute of Occupational Health, Helsinki and Turku, Finland. Mika Kivimäki is also with the Department of Psychology, University of Helsinki. Jenny Head, Jane E. Ferrie, Harry Hemingway, Martin J. Shipley, and Michael G. Marmot are with the International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London, United Kingdom.

Correspondence: Requests for reprints should be sent to Mika Kivimäki, PhD, Department of Psychology, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland (e-mail: mika.kivimaki{at}ttl.fi).

Objectives. Although sick, some people take no time off work, a phenomenon called "sickness presenteeism." This study examined the association between sickness presenteeism and incidence of serious coronary events.

Methods. The analyses were based on a cohort of 5071 male British civil servants without previous myocardial infarction. Baseline screening included measurements of health status and coronary risk factors. Absence records were assessed for the 3 years subsequent to baseline screening. The outcome of interest was incident nonfatal myocardial infarction or fatal coronary heart disease (mean length of follow-up=9.1 years).

Results. Seventeen percent of unhealthy employees took no absence during the 3-year follow-up. Their incidence of serious coronary events was twice as high as that of the unhealthy employees with moderate levels of sickness absenteeism (after adjustment for conventional risk factors, hazard ratio 1.97, 95% confidence interval=1.02, 3.83).

Conclusions. Employers and employees should be aware of the potential harmful effects caused by sickness presenteeism.

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