Association of working conditions with employer’s cost of presenteeism and sickness absence among young and early midlife municipal employees: a register-linked study

Abstract Background Working conditions are associated with sickness absence (SA), but less is known about their associations with presenteeism and, more specifically, direct cost of presenteeism and SA. We examined how working conditions are associated with these. Methods We prospectively linked the Helsinki Health Study 2017 survey on workplace atmosphere, workplace bullying, social support, organizational justice, work-family conflict, and physical working conditions with employer-provided salary and sickness absence data during a one-year follow-up among 19–39-year-old employees ( n = 3,069, women 78%). We estimated presenteeism days using the baseline Work Ability Score (WAS, work ability 0–10) and WAS-related discount factors. Employer’s cost of presenteeism and sickness absence of first 1–10 days (100% employer’s cost) and subsequent 11–60 days (30% employer’s cost) were calculated with a two-part model, adjusting for marital status and education. Results Mean annual employer’s cost of presenteeism, sickness absence of 1–10 days, and 11–60 days were €2,394, €2,229, and €541 for women, and €2,245, €1,422, and €306 for men, respectively. Overall, presenteeism costs were up to twice as high among participants reporting psychosocially demanding work, but smaller for physical working conditions. Especially those with high work-family conflicts (women: €3,108, 95% CI €2,762–3,454; men €2,701, 95% CI €1,993–3,409) and poor workplace atmosphere (women: €2,203, 95% CI €1,443–2,962; men €3,136, 95% CI €1,219–5,053) had higher presenteeism cost compared to those without. The differences in the cost of the 10 first sickness absence days were similar but smaller than those for presenteeism, while differences in 11–60 days cost could not be statistically confirmed. Adjusting for education and marital status marginally contributed to the findings. Conclusion Psychosocial working conditions were associated with higher employer’s cost of presenteeism and sickness absence, suggesting that improving them may reduce costs and support productivity, work ability, and broader economic outcomes.