Increase in sick leave episodes from short-term fine particulate matter exposure: A case-crossover study in...

Air pollution's short-term effects on a wide range of health outcomes have been studied extensively, primarily focused on vulnerable groups (e.g., children and the elderly). However, the air pollution effects on the adult working population through sick leave have received little attention. This study aims to 1) estimate the associations between particulate matter ≤2.5 μm³ (PM_2.5) and sick leave episodes and 2) calculate the attributable number of sick leave days and the consequential productivity loss in the City of Stockholm, Sweden. Individual level daily sick leave data was obtained from Statistics Sweden for the years 2011-2019. Daily average concentrations of PM_2.5 were obtained from the main urban background monitoring station in Stockholm. A case-crossover study design was applied to estimate the association between short-term PM_2.5 and onset of sick leave episodes. Conditional logistic regression was used to estimate the relative increase in odds of onset per 10 μg/m³ of PM_2.5, adjusting for temperature, season, and pollen. A human capital method was applied to estimate the PM_2.5 attributable productivity loss. In total, 1.5 million (M) individual sick leave occurrences were studied. The measured daily mean PM_2.5 concentration was 4.2 μg/m³ (IQR 3.7 μg/m³). The odds of a sick leave episode was estimated to increase by 8.5% (95% CI: 7.8-9.3) per 10 μg/m³ average exposure 2-4 days before. Sub-group analysis showed that private sector and individuals 15-24 years old had a lower increase in odds of sick leave episodes in relation to PM_2.5 exposure. In Stockholm, 4% of the sick leave episodes were attributable to PM_2.5 exposure, corresponding to €17 M per year in productivity loss. Our study suggests a positive association between PM_2.5 and sick leave episodes in a low exposure area.