Socio-demographic situation.
The subjects were mostly men: 2140 (55%) men vs. 1749 (45%) women. The mean age of the group was 49.45 ± 9.15 years, with generally lower ages among women: average age of women / men: 48.35 ± 8.48 vs 50.36 ± 9.57; p < 0.001.
The group included all people who requested more than 183 days of sick leave in the specified period of time and came from all counties of Romania. We analyzed this population referring to the development regions of Romania, eight larger regional divisions which do not have an administrative status but serve as a unit for collection of regional statistics. They are named by their geographical position in the country: (1) Northeast, (2) Southeast, (3) South, (4) Southwest, (5) West, (6) Northwest, (7) Center, and (8) Bucharest-Ilfov. The analysis of the degree of GDP in each developing region in Romania in the period 1995–2010 highlighted that the South and North Regions are two regions having a low level of economic development; on the contrary, Bucharest-Ilfov and Western and North-West Regions have a higher level of economic and social development than the other regions. (9, 10, 11) (Table I)
Table I. Number of requests depending on the development regions of Romania
Regions
|
Name
|
Number of requests (%)
|
GDP (% from EU average)
|
1
|
Northeast
|
426 (3%)
|
36
|
2
|
Southeast
|
303 (6%)
|
52
|
3
|
South-Muntenia
|
729 (8%)
|
46
|
4
|
Southwest-Oltenia
|
417 (11%)
|
42
|
5
|
West
|
283 (14%)
|
60
|
6
|
Northwest
|
198 (17%)
|
51
|
7
|
Center
|
481 (19%)
|
54
|
8
|
Bucharest-Ilfov
|
1052 (22%)
|
139
|
Total
|
Romania
|
3889 (100%)
|
58
|
Number of requests and days needed for recovery
The average number of sick days over 183 days for various pathologies was 64.81 ± 27.65. Depending on the number of days off from work due to illness requested, there were three periods of time off paid (p < 0.001):
- less than 30 days (most for 30 days): 24.40 ± 8.91 (886 requests)
- between 31 and 60 days (most for 60 days): 54.25 ± 9.68 (950 requests)
- over 61 days, (most for 90 days): 88.79 ± 4.89 (2053 requests)
An analysis according to the medical cause was also performed and clinical diagnosis was coded according to ICD-10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems.
Most requests for sickness absence were determined by musculoskeletal disorders (ICD-10 code M00-M99–46.28%), followed by traumatic injuries (ICD-10 code S00-T98–28.64%). On the 3rd place were the diseases of the circulatory system (ICD-10 code I00-I69 with 7.83%) and the diseases of nervous system (ICD-10 code G00-G69) occupied the 4th place with 4.62%. Other pathologies accounted for 12.63%; p < 0.001. (Table II)
The highest average number of days was given to musculoskeletal pathology respectively 69.54 days for one case, followed by the traumatic pathology with an average of 68.80 days for one case; p < 0.001. The average number of approved days for the pathology of the nervous system was 68.19 and occupied the 3rd place. Diseases of the circulatory system were on the 4th place with an average number of 61.80 days/case (Table II).
Men required a higher number of days to recover than women (66.03 ± 26.92 vs. 63.29 ± 28.46; p = 0.003). Also, a higher number of days of sick leave in the last year has been used by those who have retired, 71.94 ± 25.04 vs. 65.41 ± 27.31 days; p = 0.012.
Table II. Distribution of requests and rehabilitation according to ICD-10
ICD-10
|
Nervous system (G00-G99)
|
Circulatory system (I00-I99)
|
Musculoskeletal system (M00-M99)
|
Injury (S00-T88)
|
Other pathologies
|
Significance (p)
|
% of requests
|
4.62%
|
7.83%
|
46.28%
|
28.64%
|
12.63%
|
< 0.001
|
Nr. of days
|
68.19 ± 26.68
|
61.80 ± 28.75
|
69.54 ± 26.03
|
68.80 ± 25.07
|
52.08 ± 29.57
|
< 0.001
|
Rehabilitation (%)
|
50.56%
|
44.23%
|
70.06%
|
73.17%
|
58.37%
|
< 0.001
|
Social and economic impact of long-term sick leave
We investigated the relationship between the number of days needed for rehabilitation and social and economic factors, known for their impact on health and access to medical care. The number of days needed for rehabilitation was strongly correlated with the richness and opportunities of the region of origin. Correlation analysis showed a negative correlation between the number of days needed for rehabilitation and the regional position in the economic ranking, in the sense that the number of days requested decreases with the increase of the level of social and economic regional development; r=-0.89, p = 0.003, so persons from richer regions took significantly lower number of days for rehabilitation (Fig. 1). Other studies have also communicated strong correlation between patterns of mortality and disability and geographical areas of socio-economic deprivation. (12, 13). In our case, this might have several explanations: people in poorer regions may have had more severe forms of illness, sick leave days have been used not only for recovery, but either as a refuge from dissatisfaction at work, in terms of salary, work schedule or duties or to compensate for the cumbersome administrative process.
Statistical significance for the variables associated with the length of sick leave (regional development, clinical diagnosis, retirement status) was tested using multiple linear regression. From these parameters, the best coefficients were obtain only for regional community and clinical diagnosis. In conclusion, the predisposed people for using a longer period of sick leave are those who have traumatic or musculoskeletal pathology and are coming from poor socio-economic regions (Table. III).
Table III. Odds ratio (OR) and 95% confidence intervals (CI) for factors associated with longer sick leave
Variable
|
Significance (p)
|
OR (95% CI)
|
Regional development
|
< 0.001
|
2.48 (2.05–2.90)
|
Clinical diagnosis
|
< 0.001
|
10.29 (7.78–12.80)
|
From our analysis it turned out that more than 95% (95,9466%) of the requested sick leave days were confirmed but practice has shown that this percentage also includes the situations in which it was not possible to meet the timing of the current procedure and required approval to cover periods justified more by bureaucracy, less by poor health.
The gross daily amount of the allowance for temporary incapacity for work, due to a common illness, represents 75% of the average daily income. Taking into account that in Romania in 2021 the average gross salary was about 1166 EUR, the annual financial impact on the budget only for compensations for long-term sick leaves was estimated at more than 40 million EUR/year. Many authors have shown that to this amount other costs should be added: health care expenditure, impact on workers and their families or loss of productivity, which are difficult to estimate. (14) Other papers estimated that the indirect costs of work accidents and occupational diseases can be four to ten times greater than the direct costs. The ILO estimates that lost working time, workers’ compensation, interruption of production, and medical expenses could cost up to four per cent of the global GDP. (15)
Data regarding rehabilitation
The highest percentage of rehabilitation was achieved in the case of traumatic injuries (73.17%), followed by musculoskeletal diseases (70.06%). We noticed lower recovery for nervous system diseases (50.56%) and cardiovascular diseases (44.23%). In other pathologies the recovery percentage was 58.37%; p < 0.001
People who regained their work capacity were significantly younger than those who turned to other forms of social benefits, disability pension or old-age pension (47.87 ± 8.93 vs. 53.16 ± 8.43); p < 0.001. In contrast, the recovery rate was not significantly different between the two sexes (70.71% vs. 72.70%).
Their condition at the end of the period of temporary incapacity for work was analyzed globally and according to the medical cause based on the following categories:
- fully recovered (resumed professional activity)
- eligible persons to receive an work disability pension, according to the degree of work disability (permanent incapacity for work)*
- old-age pensioners
At the end of the period of temporary incapacity for work 72.43% recovered and resumed their professional activity, 21.35% benefit from work disability pension (permanent incapacity for work) and 6.22% received early or full retirement benefits.
According to the degree of work disability, 1.35% benefited from 1st degree, 7.20% from 2nd degree and 12.80% from 3rd degree.
*According to law no. 263 from 2010 on the unitary system of public pensions, the work disability is defined in relation to the degree of loss of work capacity as follows:
a) 1st degree, characterized by total loss of work capacity and self-care, persons need daily assistance for basic activities;
b) 2nd degree, characterized by the total loss of work capacity, while maintaining self-care ability;
c) 3rd degree, characterized by the loss of at least half of the work capacity, the person being able to perform a professional activity at part time. (Law no. 263 from December 16th 2010, article 69).
The analysis of the condition at the end of the period of temporary work disability depending on the medical cause (according to ICD-10 codes), showed that the highest percentage of recovery was obtained in cases of traumatic injuries − 73.17%, followed by the recovery in a percentage of 70.06% of musculoskeletal diseases. A lower recovery was observed in cases of diseases of the nervous system (50.56%) and only 44.23% of cases recovered from diseases of the circulatory system. Other pathologies recovered in 58.37% of cases; p < 0.001.
To certify the independent contribution of each of the variables (age and type of disease) to predict return to work (nominal dichotomous variable – return to work: yes/no), we performed a binary logistic regression analysis. The data suggest that age and clinical diagnosis are the best indicators for resuming professional activity at the end of the sick leave period; in this case, persons were not classified as work disabled or retired (Table. IV).
Table IV. Odds ratio (OR) and 95% confidence intervals (CI) for factors associated with return to work
Variable
|
Significance (p)
|
OR (95% CI)
|
Age
|
< 0.001
|
1.07 (1.06–1.09)
|
Clinical diagnosis
|
< 0.001
|
2.30 (1.85–2.86)
|
A different category has also been identified, caused by fatal events. Mortality rate was reduced 0.2% (8 cases): 2 from circulatory diseases (strokes), 2 in case of severe musculoskeletal diseases and 4 from traumatic injuries (complex polytrauma).