Abstract

INTRODUCTION

Absenteeism, in terms of absence of the employee at work, is a complex phenomenon, whose etiology is multiple, including individual factors and those related to the environment and to the work organization. When the absence is a result of a disease or injury medically certified, it is usually called sickness absence¹1. Permanent Commission and International Association on Occupational Health. Sub-committee on absenteeism: draft recommendations. Br J Ind Med 1973; 30: 402-3., which is considered to be an important indicator of the health conditions of workers²2. Kivimäki M, Head J, Ferrie JE, Shipley MJ, Vahtera J, Marmot MG. Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. Br Med J 2003; 327: 364..

Indicators of sickness absence (SA) are internationally accepted parameters¹1. Permanent Commission and International Association on Occupational Health. Sub-committee on absenteeism: draft recommendations. Br J Ind Med 1973; 30: 402-3., whose goal is to measure absence from work due to diseases, which enable the follow-up of variations throughout certain period, as well as the comparison of results, intra and inter-group of workers. An analysis of the indicators, associated with the profile of sick leave, provides information not only about the epidemiological situation of the workers, but also about work conditions, providing important subsidies for the planning of actions of occupational health, as well as the assessment of its effectiveness.

Estimates about the magnitude of SA range between studies and countries. Generally, sociodemographic characteristics, aspects related to nature and work conditions, as well as the type and scope of security systems are among the main factors associated with the frequency and length of the SA in different populations³3. Barham C, Begum N. Sickness absence from work in the UK. Labour Market Trends 2005; 113: 149-58.

4. Bekker MHJ, Rutte CG, van Rijswijk K. Sickness absence: a gender-focused review. Psicol Health Med 2009; 14: 405-18.

5. Piha K, Laaksonen M, Martikainen P, Rahkonen O, Lahelma E. Interrelationships between education, occupational class, income and sickness absence. Eur J Public Health 2010; 20: 276-80.^-66. Kristensen TR, Jensen SM, Kreiner S, Mikkelsen S. Socioeconomic status and duration and pattern of sickness absence. A 1-year follow-up study of 2331 hospital employees. BMC Public Health 2010; 10: 1471-2458.. Part of these differences between SA indicators can mostly be a result of the lack of uniformity in the terminologies involving assessment instruments than the very indicators used to measure these events⁷7. Hensing G, Alexanderson K, Allebeck P, Bjurulf P. How to measure sickness absence? Literature review and suggestion of five basic measures. Scand J Public Health 1998; 26: 133-44..

In Brazil, most studies about the disease profile of workers are based on data from National Social Security Institute⁸8. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Amer J Indust Med 2011; 54: 858-71.

9. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28: 1854-66.^-1010. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1 ., which generally exclude public servants. In 2010, the country counted on 9.4 million servants in the three government spheres, corresponding to 21.8% of the total number of formal contracts, out of which approximately 50% were in the municipal sphere¹¹11. Instituto de Pesquisas Econômicas Aplicadas. Ocupação no Setor Público Brasileiro: tendências recentes e questões em aberto. Comunicados do Ipea. 2011; 1-24. Disponível em: http://www.ipea.gov.br/portal/images/stories/PDFs/comunicado/110908_comunicadoipea110.pdf. (Acessado em 11 de setembro de 2014).
http://www.ipea.gov.br/portal/images/sto... .

Most epidemiological studies about SA are restricted to specific occupational groups, such as servants from health and education institutions¹²12. Gasparini SM, Barreto SM, Assunção AA. O professor, as condições de trabalho e os efeitos sobre sua saúde. Educ Pesq 2005; 31: 189-99.

13. Primo GMG, Pinheiro TMM, Sakurai E. Absenteísmo no trabalho em saúde: fatores relacionados. Rev Med Minas Gerais 2007; 17: S260-S8.^-1414. Sala A, Carro ARL, Correa AN, Seixas PHDÂ. Licenças médicas entre trabalhadores da Secretaria de Estado da Saúde de São Paulo no ano de 2004. Cad Saúde Pública 2009; 25: 2168-78.. Little is known about the epidemiological profile and the prevalence of sick leave among servants in operational activities, such as urban cleaning, lunch ladies, gravediggers, doormen, machine operators, among others. Such a gap is also seen among servants who work in surveillance positions, policing and inspection, such as municipal guards, traffic agents, public health controllers, among others. Similarly, administrative servants and technicians who do not work in the core activity, but who provide support for the public system to work, and several other professional categories that are exposed to different occupational risks have not been targeted in studies and may be damaged by the lack of progress in public health policies.

The lack of consolidated data about the health of Brazilian servants in different occupations makes it difficult to understand their disease profile, thus limiting the formulation of health promotion public policies and the prevention of conditions that mostly affect this population¹⁵15. Carneiro SAM. Saúde do trabalhador público: questão para a gestão de pessoas - a experiência na prefeitura de São Paulo. Rev Serviço Pub 2006; 57: 23-49.. In this sense, the objective was to analyze the SA profile and indicators in the Municipal Public Service of Goiânia, from January 2005 to December 2010.

METHODS

The study was conducted in the city of Goiânia, capital of the State of Goiás. Its population was estimated by the Brazilian Institute of Geography and Statistics (IBGE) in 1,393,579 residents in 2013.

This is a cross-sectional study which analyzed sick leave (SL) certified by the Municipal Medical Board, lasting than three days, from January 1^st, 2005, to December 31^st, 2010. Maternity leaves and accompanying leaves were excluded from the study.

SL is defined as the leave granted to the servants because of illness or injury, without impacting on their payment, since the granting criteria established by the Statute from the City of Goiânia¹⁶16. Lei Orgânica (revisada e atualizada até a Emenda à Lei Orgânica nº 042, de junho de 2009). Goiânia: Diário Oficial do Município, 08/07/2009. are fulfilled. This legal instrument predicts the allowance of up to three days absences caused by disease. However, when this period is longer, the servant needs to go through medical analysis for the homologation, or not, of the leave. In this study, the word servant is used as a reference to the person who legally has a public occupation according to Law n. 8,112/90.

Data referring to SL were manually extracted from the record books of medical forensics, filed in the Municipal Medical Board of Goiânia. An electronic spreadsheet was created containing the records of SLs, from where it was possible to obtain enrollment, clinical diagnosis according to the International Classification of Diseases (ICD-10) and the duration (in days) of the servant's leave. This data base also included personal and occupational information of the Human Resources System (SRH), by using the enrollment number as an identifier. Also, from the SRH it was possible to get the number of municipal servants from December of each analyzed year, used as a denominator to calculate prevalence rates.

In the description of the profile of servants on sick leave, the sociodemographic and occupational characteristics presented in the first leave were considered, as follows: sex; age; marital status; schooling; salary; occupation; job tenure; institution of work and number of work contracts. More than 60 occupations were identified in the city, being grouped in five major categories: white collar (administrative assistant and auxiliary, receptionist, judicial attorney etc.); blue collar (general services auxiliary, helper/builder, lunch lady etc.); health (nursing technician, nurse, physician etc.); surveillance (municipal guards, traffic gents, public health controller etc.); and education (teachers of early childhood and elementary school). The references for all of the categories were the occupational groups of the career plans of the city, adjusted to the similarity of the nature of the work activity.

SA indicators were constituted based on the recommendations from the Subcommittee of Absenteeism at the International Society of Occupational Health¹1. Permanent Commission and International Association on Occupational Health. Sub-committee on absenteeism: draft recommendations. Br J Ind Med 1973; 30: 402-3. and scientific literature⁷7. Hensing G, Alexanderson K, Allebeck P, Bjurulf P. How to measure sickness absence? Literature review and suggestion of five basic measures. Scand J Public Health 1998; 26: 133-44.. The main criteria were the number of individuals, episodes and days of medical leave, represented by the following formulas:

The cumulative prevalence from 2005 to 2010 was calculated by considering, in the denominator, the number of active servants in December of each year. In order to calculate the duration, according to diagnosis, the median of days was used with the respective interquartile intervals (IQR) of 25 and 75%. Besides, the prevalence ratio between genders was calculated (female/male prevalence rates).

This study was approved by the Research Ethics Committee of Hospital das Clínicas, at Universidade Federal de Goiás, protocol n. 194/2010.

RESULTS

In six years, 40,578 SLs were registered and certified by the Municipal Medical Board of Goiânia, granted to 13,408 servants who were absent for 944,722 days. The population of active servants in the City Hall of Goiânia ranged from 12,805, in 2005, to 21,280, in 2010, with an effective total of 28,230 servants in the period, out of whom 47.5% had at least one medical leave in the period.

Table 1 presents the profile of servants on leave in relation to the first leave, which was characterized by the prevalence of women (52.0%); aged more than 40 years old (55.9%); with a partner (49.9%); with elementary school or less (54.4%); earning more than six minimum wages (55.0%); professional in the education field (54.7%); who have been in the public service for more than 10 years (61.9%) and more than one professional contract (53.7%).

The cumulative prevalence of sick leave, according to diagnostic group, indicates mental and behavioral disorders (mental diseases - 26.5%); diseases of the osteomuscular system and the conjunctive tissue (osteomuscular disease - 25.1%) and injuries, poisoning and other consequences of external causes (injuris - 23.6%) as the most important in the period. The ICD chapter "factors that influence health status and contact with health services" presented a 31.2% prevalence of sick leave, and the convalescence ICD was the most frequent one (95.0%). This category is used when there is no disease, trauma or external cause (Table 2).

Also in Table 2, with regard to prevalence ratio between genders, it was possible to observe the female prevalence in all of the diagnosed groups, except for those involving skin lesions and diseases. For the others, the ratio between genders ranged from 1.3 for circulatory diseases to 5.1 to blood conditions. The median of days of sick leave, according to diagnostic groups (ICD-10), ranged from 7 to 30. Mental disorders, neoplasm, metabolic and neurological disorders presented the highest values (30 days), while infectious and respiratory conditions had the lowest medians (seven days).

Considering the three chapters of the most prevalent ICD-10, the percentage analysis of the ICD groups in each of them indicated mood disorders (62.1% of mental disorders), back pain (41% of the osteomuscular diseases) and ankle and foot trauma (30% of the injuries) as the most important ones (Table 3).

As observed in Table 4, the city presented a mean annual staff of 17,270 servants, out of whom 23% were absent from work due to diseases, with mean duration of 40 missed work days in a year. The same worker may have had several episodes of absence in the period, which was verified by the prevalence of 39.2% of sick leave, revealing that about 70% of servants on leave had more than one leave per year, with mean duration of 23 days lost per episode. After gender stratification, the percentage of women who were on leave in relation to all workers on leave (26.2%), as well as the number of their leaves (44.4%) was higher when compared to men in the analyzed years (15.9 and 27.4%, respectively). However, by observing indicators of duration, mean time of missed work days a year and the length of each episode, they were higher among the male gender (44 and 26 days, respectively).

Table 5 presents the SA indicators according to occupation. The prevalence of SA was higher among teachers (54.4%), with a ratio of 3.2 episodes per servant on leave, mean duration of 23 days per sick leave and 77 missed work days in the period. Among blue collar workers, the cumulative prevalence of sick leave was higher (181.1%), with an average of 3.6 episodes per servant, mean duration of 24 days per episode and 87 missed work days in the period.

DISCUSSION

This study analyzed a set of official and widely representative data of municipal servants in the city of Goiânia in several professional categories, thus producing important SA indicators. It is worth to mention that the analysis of the SA profile enabled to identify subgroups of workers, who are potentially vulnerable in terms of absence due to diseases. These results provide important subsidies for the planning of preventive and health promotion actions, as well as for the optimized management of public resources that can prioritize more vulnerable groups.

Approximately half of the analyzed population presented at least one sick leave, certified by an auditor physician, in a six-year period, with an average of three episodes per servant. The present results confirm the magnitude of this phenomenon in the public service, as demonstrated in other analyses¹⁴14. Sala A, Carro ARL, Correa AN, Seixas PHDÂ. Licenças médicas entre trabalhadores da Secretaria de Estado da Saúde de São Paulo no ano de 2004. Cad Saúde Pública 2009; 25: 2168-78.^,1717. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36.

18. Andrade TB, Souza MGC, Simões MPC, Andrade FB. Prevalência de absenteísmo entre trabalhadores do serviço público Sci Med 2008; 18: 166-71. Disponível em: http://revistaseletronicas.pucrs.br/ojs/index.php/scientiamedica/article/download/3950/7825. (Acessado em 11 de setembro de 2014).
http://revistaseletronicas.pucrs.br/ojs/... ^-1919. Santos JP, Mattos AP. Absentismo-doença na prefeitura municipal de Porto Alegre, Rio Grande do Sul, Brasil. Rev Bras Saúde Ocupacional 2010; 35: 148-56.. The SA affects many workers at productive age, with a direct impact on their quality of life and labor power. International studies suggest that the history of SA increases with the risk of recurrence of episodes²⁰20. Reis RJ, Utzet M, La Rocca PF, Nedel FB, Martín M, Navarro A. Previous sick leaves as predictor of subsequent ones. Int Arch Occupational Envir Health 2011; 84: 491-9., invalidity retirement²¹21. Wallman T, Wedel H, Palmer E, Rosengren A, Johansson S, Eriksson H, et al. Sick-leave track record and other potential predictors of a disability pension. A population based study of 8,218 men and women followed for 16 years. BMC Public Health 2009; 9: 104. and mortality²²22. Ferrie JE, Vahtera J, Kivimäki M, Westerlund H, Melchior M, Alexanderson K, et al. Diagnosis-specific sickness absence and all-cause mortality in the GAZEL study. J Epidemiol Community Health 2009; 63: 50-5..

The higher prevalence of sickness absence among women, workers aged more than 40 years old, who have been in the service for longest and with lower schooling is in accordance with other studies³3. Barham C, Begum N. Sickness absence from work in the UK. Labour Market Trends 2005; 113: 149-58.^,1414. Sala A, Carro ARL, Correa AN, Seixas PHDÂ. Licenças médicas entre trabalhadores da Secretaria de Estado da Saúde de São Paulo no ano de 2004. Cad Saúde Pública 2009; 25: 2168-78.^,1717. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36.^,1818. Andrade TB, Souza MGC, Simões MPC, Andrade FB. Prevalência de absenteísmo entre trabalhadores do serviço público Sci Med 2008; 18: 166-71. Disponível em: http://revistaseletronicas.pucrs.br/ojs/index.php/scientiamedica/article/download/3950/7825. (Acessado em 11 de setembro de 2014).
http://revistaseletronicas.pucrs.br/ojs/... . With regard to sex, the higher prevalence among women seems to be influenced by a combination of biological, psychosocial and cultural factors, ranging from multiple roles, with work-family interfaces, to inter and intra-activity gender inequalities⁴4. Bekker MHJ, Rutte CG, van Rijswijk K. Sickness absence: a gender-focused review. Psicol Health Med 2009; 14: 405-18.. These factors become more prominent in activities that are prevalently performed by females, such as in the health, education and cleaning fields, which are characterized by high emotional demands, low salaries, lack of autonomy, support and perspective in the career⁴4. Bekker MHJ, Rutte CG, van Rijswijk K. Sickness absence: a gender-focused review. Psicol Health Med 2009; 14: 405-18.. In general, the increasing schooling can contribute with better professional opportunities, better income and, consequently, better life conditions, as well as more access to health services⁵5. Piha K, Laaksonen M, Martikainen P, Rahkonen O, Lahelma E. Interrelationships between education, occupational class, income and sickness absence. Eur J Public Health 2010; 20: 276-80.. The deeper knowledge about preventive measures and the adoption of safer practices in the work place are added to these factors, thus affecting health levels and, potentially, absenteeism²³23. Piha K, Laaksonen M, Martikainen P, Rahkonen O, Lahelma E. Socio-economic and occupational determinants of work injury absence. Eur J Public Health 2013; 23: 693-8..

The natural aging of organic structures associated with the longer time of exposure of the body to occupational risk factors can explain the higher prevalence of sickness absence among workers in older age groups and those who have been in service for a longer period⁶6. Kristensen TR, Jensen SM, Kreiner S, Mikkelsen S. Socioeconomic status and duration and pattern of sickness absence. A 1-year follow-up study of 2331 hospital employees. BMC Public Health 2010; 10: 1471-2458.^,88. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Amer J Indust Med 2011; 54: 858-71.. It is worth to mention, however, that approximately 50% of the leaves occurred in the three first years of their career, among servants who were still in the probationary period. It is possible that there is deficit in the medical evaluation at the time of admission, or even the presence of diseases with long latency period that manifested in the first years of service; there may be flaws in training programs and adaptation of newly hired employees to the new occupations²⁴24. Van Nieuwenhuyse A, Fatkhutdinova L, Verbeke G, Pirenne D, Johannik K, Somville PR, et al. Risk factors for first-ever low back pain among workers in their first employment. Occup Med 2004; 54: 513-9.. Besides, becoming a civil servant via a public selection process usually takes place in adulthood; therefore it is difficult to distinguish the effects of age from those resulting from time of service¹⁸18. Andrade TB, Souza MGC, Simões MPC, Andrade FB. Prevalência de absenteísmo entre trabalhadores do serviço público Sci Med 2008; 18: 166-71. Disponível em: http://revistaseletronicas.pucrs.br/ojs/index.php/scientiamedica/article/download/3950/7825. (Acessado em 11 de setembro de 2014).
http://revistaseletronicas.pucrs.br/ojs/... . However, further analyses are necessary to understand what happens in the early stage of the career, so that efficient interventions can be proposed.

The higher prevalence of SA among servants with more than one work contract reinforces the relationship between workload and diseases. A study conducted in Denmark²⁵25. Stapelfeldt CM, Nielsen CV, Andersen NT, Krane L, Fleten N, Borg V, et al. Are environmental characteristics in the municipal eldercare, more closely associated with frequent short sick leave spells among employees than with total sick leave: a cross-sectional study. BMC Public Health 2013; 13: 578. with employees in municipal services showed the association between number and duration of leaves and the high workload. In general, those who have more than one job accumulates more work hours and, even though this was not the object of this study, it is known that long work hours have been associated with worse physical and mental health²⁶26. Sparks K, Cooper C, Fried Y, Shirom A. The effects of hours of work on health: a meta-analytic review. J Occupational Organizational Psychol 1997; 70: 391-408., which could contribute with absenteeism.

The identification of clinical causes resulting from mental diseases, osteomuscular disorders and injuries as the most prevalent ones is in accordance with several studies³3. Barham C, Begum N. Sickness absence from work in the UK. Labour Market Trends 2005; 113: 149-58.^,88. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Amer J Indust Med 2011; 54: 858-71.^,2222. Ferrie JE, Vahtera J, Kivimäki M, Westerlund H, Melchior M, Alexanderson K, et al. Diagnosis-specific sickness absence and all-cause mortality in the GAZEL study. J Epidemiol Community Health 2009; 63: 50-5., in spite of the alternate positions of these conditions depending on gender, age and occupation. If mental disorders are prevalent in the public context¹⁷17. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36.^,1919. Santos JP, Mattos AP. Absentismo-doença na prefeitura municipal de Porto Alegre, Rio Grande do Sul, Brasil. Rev Bras Saúde Ocupacional 2010; 35: 148-56.^,2727. Silva EBF, Tomé LAO, Costa TJG, Santana MCCP. Transtornos mentais e comportamentais: perfil dos afastamentos de servidores públicos estaduais em Alagoas, 2009; Mental and behavioral disorders: profile of removals of state public servants in the state of Alagoas, Brazil, in 2009. Epidemiol Serv Saúde 2012; 21: 505-14., in the private one injuries stand out, as demonstrated in studies estimating the rates of sickness benefit in the Brazilian employed population⁸8. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Amer J Indust Med 2011; 54: 858-71.

9. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28: 1854-66.^-1010. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1 .. Such authors suggest that the two first groups of diseases are more associated to chronic conditions, influenced by environmental conditions and work processes, while the latter (injuries), especially acute ones, would be partly related to the precariousness of safe labor measures and urban violence.

Still concerning the causes of SA, the high prevalence among women was observed in almost all of the diagnosed groups, except for injuries, which presented higher frequency of leaves among men, which corroborates other sutides⁸8. Barbosa-Branco A, Souza WR, Steenstra IA. Incidence of work and non-work related disability claims in Brazil. Amer J Indust Med 2011; 54: 858-71.^,2222. Ferrie JE, Vahtera J, Kivimäki M, Westerlund H, Melchior M, Alexanderson K, et al. Diagnosis-specific sickness absence and all-cause mortality in the GAZEL study. J Epidemiol Community Health 2009; 63: 50-5.. In general, men and women are subject to the same risk factors, be it in the workplace or anywhere else. However, behavioral characteristics may impose a specific morbidity pattern for both, especially when it comes to injuries, which, in the general population, are more prevalent among men, especially those related to traffic (4.3 male victims for one female victim)²⁸28. Reichenheim ME, de Souza ER, Moraes CL, de Mello Jorge MH, da Silva CM, et al. Violence and injuries in Brazil: the effect, progress made, and challenges ahead. Lancet 2011; 377: 1962-75..

The longer absence time caused by mental disorders is in accordance with other studies⁹9. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28: 1854-66.^,2929. Koopmans PC, Bultmann U, Roelen CA, Hoedeman R, van der Klink JJ, Groothoff JW. Recurrence of sickness absence due to common mental disorders. Int Arch Occup Environ Health 2011; 84: 193-201.. The duration of SA is considered to be an important indicator of the severity of the event, since the longer a person stays away from work, the fewer the chances of return, and the higher the risk of recurrence of sick leave and disability pension²⁹29. Koopmans PC, Bultmann U, Roelen CA, Hoedeman R, van der Klink JJ, Groothoff JW. Recurrence of sickness absence due to common mental disorders. Int Arch Occup Environ Health 2011; 84: 193-201.. On the other hand, infectious and respiratory diseases have been more associated with short-term leaves, less severe ones, and this result is also observed among servants from the Secretariat of Health of the State of São Paulo¹⁴14. Sala A, Carro ARL, Correa AN, Seixas PHDÂ. Licenças médicas entre trabalhadores da Secretaria de Estado da Saúde de São Paulo no ano de 2004. Cad Saúde Pública 2009; 25: 2168-78..

With regard to subgroups of mental diseases, mood disorders were responsible for most leaves, which is in accordance with studies that point out depression problems as the main cause of absenteeism⁹9. Barbosa-Branco A, Bültmann U, Steenstra I. Sickness benefit claims due to mental disorders in Brazil: associations in a population-based study. Cad Saúde Pública 2012; 28: 1854-66.^,1717. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36.

18. Andrade TB, Souza MGC, Simões MPC, Andrade FB. Prevalência de absenteísmo entre trabalhadores do serviço público Sci Med 2008; 18: 166-71. Disponível em: http://revistaseletronicas.pucrs.br/ojs/index.php/scientiamedica/article/download/3950/7825. (Acessado em 11 de setembro de 2014).
http://revistaseletronicas.pucrs.br/ojs/... ^-1919. Santos JP, Mattos AP. Absentismo-doença na prefeitura municipal de Porto Alegre, Rio Grande do Sul, Brasil. Rev Bras Saúde Ocupacional 2010; 35: 148-56.^,2727. Silva EBF, Tomé LAO, Costa TJG, Santana MCCP. Transtornos mentais e comportamentais: perfil dos afastamentos de servidores públicos estaduais em Alagoas, 2009; Mental and behavioral disorders: profile of removals of state public servants in the state of Alagoas, Brazil, in 2009. Epidemiol Serv Saúde 2012; 21: 505-14.. Most of the analyzed population works by providing services to the population in the fields of education and health, and these occupations are characterized by high psychological demands, low social support and control over the work situation, being associated with the higher risk of leaves due to psychiatric morbidities¹³13. Primo GMG, Pinheiro TMM, Sakurai E. Absenteísmo no trabalho em saúde: fatores relacionados. Rev Med Minas Gerais 2007; 17: S260-S8.^,3030. Wieclaw J, Agerbo E, Mortensen PB, Bonde JP. Risk of affective and stress related disorders among employees in human service professions. Occup Environ Med 2006; 63: 314-9..

Among osteomuscular diseases, the most frequent subgroups were those related to back pain, and similar findings have been observed among workers in private¹⁰10. Vieira ER, Albuquerque-Oliveira PR, Barbosa-Branco A. Work disability benefits due to musculoskeletal disorders among Brazilian private sector workers. BMJ Open 2011; 1 . and public services¹⁹19. Santos JP, Mattos AP. Absentismo-doença na prefeitura municipal de Porto Alegre, Rio Grande do Sul, Brasil. Rev Bras Saúde Ocupacional 2010; 35: 148-56. in Brazil. Such a dysfunction, that is mostly mechanic, in general, can be prevented in the primary level by using simple resources, such as health-related education.

With regard to subgroups of injuries, lower limb traumas, usually associated with transportation accidents, were more frequent in leaves, corroborating the findings of a study with state servants of Santa Catarina¹⁷17. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36.. In Brazil, traffic accidents cause strong impact on morbimortality²⁸28. Reichenheim ME, de Souza ER, Moraes CL, de Mello Jorge MH, da Silva CM, et al. Violence and injuries in Brazil: the effect, progress made, and challenges ahead. Lancet 2011; 377: 1962-75., and it is known that workers have the same disease profile found in the general population, which was confirmed by our results.

Most SA indicators present similar forms of calculation, even if using different terminologies. The adopted criteria include the number of individuals on leave, episodes of leave and missed work days⁷7. Hensing G, Alexanderson K, Allebeck P, Bjurulf P. How to measure sickness absence? Literature review and suggestion of five basic measures. Scand J Public Health 1998; 26: 133-44.. Some studies, however, do not clarify the inception point of the sick leave, which makes it difficult to make a direct comparison of their prevalence rates.

The SA prevalence (people on leave) in the city of Goiânia was close to that observed in the State Public Service of Santa Catarina¹⁷17. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36. (19.3%) and lower to that found among municipal servants from Vitória, Espírito Santo¹⁸18. Andrade TB, Souza MGC, Simões MPC, Andrade FB. Prevalência de absenteísmo entre trabalhadores do serviço público Sci Med 2008; 18: 166-71. Disponível em: http://revistaseletronicas.pucrs.br/ojs/index.php/scientiamedica/article/download/3950/7825. (Acessado em 11 de setembro de 2014).
http://revistaseletronicas.pucrs.br/ojs/... (75.2%). For the latter, a sample of 400 individuals was analyzed, and most of them were women and teachers. With regard to the prevalence and mean duration of leaves, it is similar to that found among municipal servers of Porto Alegre (44.4% and 21.1 days, respectively)¹⁹19. Santos JP, Mattos AP. Absentismo-doença na prefeitura municipal de Porto Alegre, Rio Grande do Sul, Brasil. Rev Bras Saúde Ocupacional 2010; 35: 148-56., and, if it were not for the point of insertion of the leaves (≥ 15 days), it would be the closest one to this study, since all secretariats and professional categories were included in the analysis. The comparison of our results with other studies should be careful, due to the adopted methodological differences.

In all of the investigated years, women have been absent more often, however, men spent more days away from work, which is also observed in a historical series of SA among public servants of Santa Catarina¹⁷17. Cunha JB, Blank VLG, Boing AF. Tendência temporal de afastamento do trabalho em servidores públicos (1995-2005). Rev Bras Epidemiol 2009; 12: 226-36.. One explanation for this difference would be that men are possibly absent from work due to more severe reasons or longer time of incapacity to perform their occupation than women¹⁴14. Sala A, Carro ARL, Correa AN, Seixas PHDÂ. Licenças médicas entre trabalhadores da Secretaria de Estado da Saúde de São Paulo no ano de 2004. Cad Saúde Pública 2009; 25: 2168-78.. However, further analyses would be necessary to confirm this hypothesis.

The results of this study reveal a tendency of stability for all SA indicators throughout the six analyzed years. Even though the city of Goiânia has presented, since 2004, a Occupational Health and Safety Program, which enabled important progress, especially concerning surveillance and control of environmental risks, it is possible to assume that changes are only detected after a while, or that the lack of an epidemiological profile that could identify more vulnerable groups has made it difficult to elaborate more assertive policies to promote health and prevent diseases in this population, thus contributing with the maintenance of rates throughout the period.

Approximately half of the teachers had at least one leave in the period, which is more than the frequency observed in the State Secretariat of Education of São Paulo³¹31. Porto MA. Faltas e licenças médicas: o absenteísmo na Secretaria de Estado da Educação de São Paulo [Dissertação]. São Paulo: Universidade de São Paulo; 2009. 102 p. Disponível em: http://www.teses.usp.br/teses/disponiveis/6/6136/tde-28062011-101241/publico/MarioPorto.pdf. (Acessado em 11 de setembro de 2014).
http://www.teses.usp.br/teses/disponivei... , in which absences caused by health reasons reached about 20% of the teachers. Some studies¹²12. Gasparini SM, Barreto SM, Assunção AA. O professor, as condições de trabalho e os efeitos sobre sua saúde. Educ Pesq 2005; 31: 189-99.^,2727. Silva EBF, Tomé LAO, Costa TJG, Santana MCCP. Transtornos mentais e comportamentais: perfil dos afastamentos de servidores públicos estaduais em Alagoas, 2009; Mental and behavioral disorders: profile of removals of state public servants in the state of Alagoas, Brazil, in 2009. Epidemiol Serv Saúde 2012; 21: 505-14.^,3232. Reis EJFB, Carvalho FM, Araújo TM, Porto LA, Neto AMS. Trabalho e distúrbios psíquicos em professores da rede municipal de Vitória da Conquista, Bahia, Brasil Work and psychological distress among public school teachers in Vitória da Conquista. Cad Saúde Pública 2005; 21: 1480-90. justify that the high prevalence of absence among teachers, especially due to mental disorders, may be a result of the high emotional demand and the low control towards the work situation, as well as the exhaustive workload, due to the multiple jobs and precarious work conditions to which they are exposed. These explanations also apply to health professionals¹³13. Primo GMG, Pinheiro TMM, Sakurai E. Absenteísmo no trabalho em saúde: fatores relacionados. Rev Med Minas Gerais 2007; 17: S260-S8., who similarly presented high rates of SA.

Blue collar workers presented more frequency and duration of sick leave, and these results are similar to those in a Danish study⁶6. Kristensen TR, Jensen SM, Kreiner S, Mikkelsen S. Socioeconomic status and duration and pattern of sickness absence. A 1-year follow-up study of 2331 hospital employees. BMC Public Health 2010; 10: 1471-2458., which found clear differences in SA indicators between occupational groups, especially between manual workers (cleaning, among others). In this study⁶6. Kristensen TR, Jensen SM, Kreiner S, Mikkelsen S. Socioeconomic status and duration and pattern of sickness absence. A 1-year follow-up study of 2331 hospital employees. BMC Public Health 2010; 10: 1471-2458., the authors claimed that professional categories with higher schooling and better positions presented fewer episodes, shorter duration, and that SA is inversely proportional to the socioeconomic gradient.

The repercussions of the frequency and duration of SA, especially in the fields of education and health, impact the society, since it is not always possible to maintain the necessary workforce to cover for these absences, which can be unexpected, thus leading to reduced quality of the services provided for the population and to increasing costs coming from the need to immediately hire replacement workers and invest in the education of these professionals. This has a direct impact on public expenses³³33. Cooper C, Dewe P. Well-being: absenteeism, presenteeism, costs and challenges. Occupational Med 2008; 58: 522-4..

This study presents several limitations, and some of them are characteristic of descriptive studies, therefore, it is not possible to establish relationships of causality. The analyzed data did not allow separating occupational morbidities from common diseases, therefore, it was not possible to analyze the impact of work on the morbidity profile of servants. Besides, the analyses did not include the difference between short and long-term sick leave, therefore, potentially different situations in terms of severity, social and economic repercussions were considered as having the same significance. Besides these limitations, there is also the fact that the universe of sickness absences can be underestimated, since episodes of up to three days/month were recorded in the work place, or simply allowed by the people I charge. Therefore, these non-quantified data could express much higher indicators, however, outside the scope of this study.

Further studies contemplating these matters are recommended, as well as a deeper analysis of the morbidity profile, according to professional category, of the factors associated with SA among servants in the probationary period and more than one work contract, as well as the specific characteristics involving the recurrence of sick leave, which often result in professional readaptation and disability pension.

Even with the presented limitations, the designed profile is an important step to understand the characteristics of sickness absence and to know which should be part of deeper discussions, since, based on epidemiological evidence, a debate can be encouraged in the city regarding the conditions and the management of the work environment, which, in the public service, has some specificities in terms of organization.

CONCLUSION

Sickness absence indicators express the magnitude of this phenomenon in the city of Goiânia, and prevention seems to be the best way to prevent or minimize this problem, since actions consider the work environment, the workers and social relations during planning. In general, the morbidity profile and the characteristics of servants on sick leave because in Goiânia are in accordance with other Brazilian studies. This shows that, in some aspects, the disease profile is similar in the public service, even in geographically distant regions and in different administrative spheres.

ACKNOWLEDGEMENTS

To the Municipal Secretariat of Administration and Human Resources of Goiânia (SMARH), especially Dr. Orion Elias Sampaio, CEO of the Municipal Medical Board, for providing the necessary data for the study.

References

Publication Dates

History