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Introduction

Sickness absence is a growing problem in several European countries. It is a complex bio-psycho-social phenomenon determined by factors at the structural, organisational, group and individual levels in addition to the biomedical level. Variation in sickness absence is often studied in relation to social groups, trades and longitudinally but more seldom in a geographic context. In Sweden there are considerable regional differences in sickness absence. The municipalities are employers with an identical assignment all over the country but with large variation in organization and personnel policy as well as in level of sickness absence among their employees. Municipal employees also constitute a vulnerable group with high level of sickness absence. The aim was accordingly to study to what extent the sickness absence differences between municipalities among their employees are determined by organisational factors at the work place and demographic and socio-economic factors respectively.

Material

A random sample of 60 out of Sweden’s 290 municipalities was selected. A questionnaire with focus on perceived organizational climate, social support, supportive leadership, distributive justice, work commitment, stress, health and absence culture was sent out to a representative sample of 15,000 employees in the sector of nursing and social care of elderly and disabled. The response rate was 58.4%. A database of the 60 municipalities was constructed with aggregated questionnaire data and official register data concerning the number and income level of inhabitants, level of expenses for social care and sickness absence among the municipality employees.

Results

Bivariate analyses revealed a lot of significant covariations between perceived organizational climate, social support, supportive leadership, distributive justice, work commitment, stress and health. Absence culture was only related to health. The level of sickness absence was only related to health and absence culture. The socioeconomic and demographic characteristics of the municipalities were not related to the level of sickness absence. In a multiple regression analysis adjusted for income level and number of inhabitants of the municipalities, health and attitude to sickness absence remained as significant predictors of sickness absence level (R²_adj=.19; p=.003).

Conclusions

Although psychological and social factors at work such as organizational climate and leadership characteristics were related to the employees’ health, they did not have an independent relation to sickness absence. Aggregated data of self-rated health is a relevant indicator of organizational health. Absence culture is an important independent determinant of the level of sickness absence.