Occupational differences in sickness presenteeism in the baseline survey of the German National Cohort (NAKO)

This study examines the relationship between occupation and sickness presenteeism (SP) among German employees. In addition, it investigates occupation-specific differences in SP according to supervisory or managerial responsibilities.

A total of 86,855 employees (average age: 45.7 ± 10.5, 48.3% men, and 51.7% women) from the German National Cohort (NAKO) who had reported illness at least once in the past 12 months were included in this cross-sectional study (response: 15.6%). Data were collected between 2014 and 2019. Occupations were grouped into 14 segments based on the German Classification of Occupations 2010. SP was defined as attending work despite illness at least once within the past 12 months. Robust Poisson regression analyses were conducted to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for SP, comparing each occupational segment with all other occupations combined as the reference group. Additional analyses compared SP between employees with and without supervisory or managerial responsibilities overall and within each occupational segment, and by sex.

Among employees who had been ill at least once in the past 12 months, 76.4% reported SP. The highest prevalence of SP was observed in healthcare, social and cultural service occupations, trade, and food industry and hospitality. Overall, employees with supervisory or managerial responsibilities had a higher SP prevalence than those without such responsibilities (PR = 1.08; 95% CI = 1.07-1.10). This association was stronger among men (PR = 1.11; 95% CI = 1.09-1.12) than among women (PR = 1.04; 95% CI = 1.02-1.06). In general, the elevated prevalence of SP among supervisors and managers was not confined to specific occupational segments. Rather, certain occupational segments exhibited consistently higher SP prevalence regardless of hierarchical position.

Among German employees, SP prevalence varies notably across occupations, with above-average levels in healthcare, social and cultural service, trade, and food industry and hospitality. Supervisory and managerial responsibilities were associated with a modestly higher prevalence of SP, with a stronger association among men than women. However, occupation-specific patterns were broadly similar across hierarchical groups, indicating that SP is likely influenced by a combination of occupational context and hierarchical position.