Trajectories of sickness absence in healthcare workers: a cohort study in a Spanish hospital between 2018 and 2023

BACKGROUND: Sickness absence (SA) is a key indicator of health and job performance. The COVID-19 pandemic increased workload and stress, potentially affecting healthcare workers' (HCWs) health and retention. This study aimed at identifying vulnerable HCW groups by analysing SA trajectories before and after the pandemic. METHODS: A retrospective longitudinal study was conducted using administrative data from HCWs at Hospital del Mar, Barcelona, Spain, 2018-2023. SA was measured as cumulative days per semester. Latent Class Growth Analysis with zero-inflated Poisson models identified SA trajectories. The associations between socio-demographic and employment variables (occupation, shifts, care setting) and SA trajectories was analysed using bivariate analysis and multinomial logistic regression, yielding adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). RESULTS: An overall increase in accumulated SA days per semester was observed among HCWs between 2018 and 2023. Five SA trajectories were identified: zero (7.8%), low (53.7%), degrowing (16.4%), growing (15%), and high (7%). Women were more likely to belong to growing (aOR: 1.54; 95% CI: 1.16-2.05) and high (aOR: 1.77; 95% CI: 1.14-2.74) trajectories. Aides were strongly associated with the high trajectory (aOR: 30.7; 95% CI: 9.55-98.7). Working in non-direct care areas was associated with the zero trajectory (aOR: 2.86; 95% CI: 1.79-4.58) and negatively to the high trajectory (aOR: 0.54; 95% CI: 0.31-0.93). Night shifts were associated with the high trajectory (aOR: 1.78; 95% CI: 1.21-2.60). CONCLUSIONS: SA among HCWs increased 2018-2023, following distinct trajectories related to gender, care level, and occupation. Persistent pandemic effects and key sociodemographic and work-related factors shape these patterns. Targeted occupational health interventions could mitigate SA in high-risk groups and enhance healthcare system resilience.