Outcome of stable angina in a working population:: the burden of sickness absence

Background The decline in acute event rates among patients with stable angina emphasizes the need for outcome events that are commonly experienced, externally observed and sensitive to changing functional impairments. In the absence of previous studies, we sought to determine the burden of medically certified spells of sickness absence among individuals with angina and their relation to risk factors and co-morbidity. Design and methods A prospective study of 33148 employees and 1 year experience of medically certified sickness absence in 341 physician-diag nosed angina patients (417 absence spells, total absence days 9733). Results Among individuals with angina, sickness absence occurred at a rate of 125 spells per 100 person-years, with age and sex adjusted hazard ratios (compared with their colleagues with no chronic diseases) of 2.90 (95% confidence interval 2.51-3.36), greater than the effect of prolapsed intervertebral disc. Co-morbid diseases were stronger predictors of absence than behavioural risk factors or cardiovascular diseases, and explained 71% of the excess risk of absence in angina. Conclusion In a working population, angina has a significant impact on sick leave, largely because of co-morbid diseases. Angina intervention studies that include employed patients should measure, and seek to reverse, this prognostic burden.