Results
Sick Leave Due to Common Non-cardiovascular Diseases
The incidence of SL caused by common non-CV diseases was 13.9%, and the median duration of SL was 11 days (Table 1, Non-CV diseases). Both incidence and duration were higher in women than in men, in smokers than in non-smokers, and in BC than in WC workers. Age ≥45 years was associated with a lower incidence but longer duration of SL. Workers with moderate-to-high CVR had an SL incidence that was not significantly different from low CVR individuals, but SL duration for moderate/high individuals was about twice as long (median duration 18 vs. 11 days, P < 0.0001).
Non-CV diseases causing SL episodes were mainly: (i) diseases of the respiratory system (ICD 460–519); (ii) diseases of the musculoskeletal system and connective tissue (ICD 710–739); (iii) injury and poisoning (ICD 800–999); (iv) poorly defined conditions (ICD 780–799); (v) infectious or parasitic diseases (ICD 001–139); (vi) diseases of the digestive system (ICD 520–579); (vii) mental disorders (ICD 290–319); (viii) and diseases of the nervous system and sense organs (ICD 320–389). In each of these conditions, the median SL duration was significantly longer in individuals with moderate-to-high CVR than with low CVR.
Sick Leave Due to Work-related Accidents
The overall incidence of SL caused by work-related accidents (6.8%) was significantly lower than that caused by common non-CV diseases, but the median duration (11 days) was similar (Table 1, Work-related accidents). The duration was slightly longer in women and individuals ≥45 years, but not in smokers. On the other hand, BC workers had a slightly shorter median duration of SL. Moreover, moderate-to-high CVR was significantly associated with a longer median duration of SL due to work-related accidents.
Sick Leave Due to Common Cardiovascular Diseases
As expected for the relatively young population of workers included in the ICARIA study, the incidence of SL caused by common CV diseases was very low (0.10%), i.e. much lower than the incidence of SL due to non-CV diseases or to work-related accidents (Table 1, CV diseases). The occurrence of CV-related SL was significantly higher in men, individuals ≥45 years, smokers, and BC workers. Moreover, the risk of SL due to CV disease for moderate-to-high CVR individuals, although rather low (0.66%), was >10 times higher than for low CVR individuals (0.06%, P < 0.0001). On the other hand, the median duration of CV-related SL was notably long (92 days), and significantly longer in men, older workers, and smokers. The median SL duration was also significantly greater for individuals at moderate/high CVR than for individuals at low CVR.
Association With Cardiovascular Treatment
As shown in Table 2, 26% of workers with moderate-to-high CVR and 3% of those with low CVR were being treated for arterial hypertension and/or hyperlipidaemia. The median duration of SL caused by common non-CV diseases or work-related accidents for these treated patients (both higher and lower CVR) was significantly longer than that of subjects without pharmacological treatment (P < 0.0001 in all cases). A similar trend was observed for CV-related SL, but the difference did not reach statistical significance, likely because of the small sample size. Finally, pharmacologically treated patients were older than untreated ones, with the age difference small in the moderate-to-high CVR group (54.5 ± 7.5 vs. 50.1 ± 10.3; P < 0.0001) and more pronounced in the low CVR group (47.7 ± 8.7 vs. 34.1 ± 9.7; P < 0.0001).
Role of Associated Variables
The results of the Poisson regression analyses for the association of CVR with SL duration following covariate adjustment are presented in Table 3. Moderate-to-high CVR was associated with a significant increase in SL duration for CV or non-CV causes. Although the inclusion of age in the model reduced the magnitude of the estimated association between CVR and SL duration, the association remained significant for all three SL categories. Results from models that also adjusted for sex, occupation, and smoking status continued to reveal a significant association between CVR and SL duration for SL due to non-CV diseases and CV diseases, but no significant association for work-related accidents.
Cost Analysis
Estimates of the additional costs associated with increased SL taken by individuals at higher CVR are summarized in Table 4. We estimated that the lengthened duration of non-CV-disease-related SL in individuals with moderate-to-high CVR amounted to additional costs of €2 151 920.99, and that €3 649 543.19 would be due to overt CV diseases, with a total additional cost of €5 801 464.18 during only the first year following initial medical examination.