臺灣博碩士論文加值系統

背景：工作者因為健康因素而無法工作，長年來為歐盟各國關切的議題。許多國外學術研究指出，除工作者個人的健康狀況之外，影響「因病缺勤」天數的因素包含個人、職場與國家社會三大層面。在個人層面，「社會經濟階層」是影響健康狀況與因病缺勤天數的重要因素。國際文獻指出，工作者的社會經濟階層較低，有較差的健康狀況；但較高社會經濟階層的工作者，卻有較高的因病缺勤狀況。社會階層對於工作者健康及因病缺勤的影響，台灣至今仍少有研究。
目標：此研究旨在檢視台灣受僱者因病缺勤的狀況，並探討健康狀況及社會經濟階層對因病缺勤的相關。

方法：本研究利用勞委會勞工安全衛生研究所於2010年舉辦的「工作環境安全衛生狀況認知調查」，調查內容包含社會經濟階層 (職等及教育程度)、健康狀況 (確診疾病及自覺不適)、年齡、家庭負荷、工作特性 (每週工時及公司規模)、職場社會心理風險 (僱用模式、就業保障、工作控制、工作負荷及職場正義)與因病缺勤狀況。研究族群為年齡介於25-65歲之間的受僱者，共有9,503名男性與7,769名女性。

結果：最近12 個月曾經因為健康問題（包括生病、治療或醫療檢查）整天請假或無法工作的比例，男性有26.72%，低於女性的31.23%。在羅吉斯迴歸中，健康狀況越不佳者 (確診疾病數量越多或自覺不適數量越多)，較易有因病缺勤的現象，且缺勤日數亦越多。而在控制控制健康狀況及其他變項後，以「職等」為社會經濟階層 (以「非技術性藍領」為參考組)，男性技術性藍領工作者的因病缺勤較嚴重 (OR=1.21)，缺勤日數亦較多 (少日數OR=1.18，多日數OR=1.48)；而女性則為技術性白領因病缺勤較嚴重 (OR=1.19)，但缺勤日數以1-9日的少日數為多 (少日數OR=1.20，多日數OR=1.09)；以「教育程度」為社會經濟階層 (以「國小以下及國初中」為參考組)，男性以高中職 (OR=0.79)與專科大學 (OR=0.83)的因病缺勤較少，日數亦較短，女性方面則無明顯差異。

結論與建議：相較於非技術性藍領，男性技術性藍領與女性技術性白領有較多的因病缺勤，但前者的缺勤日數較多，後者的缺勤日數則較少，應加以關注與管理。未來調查或研究應對因病缺勤定義與概念加以釐清，以利進行更精確的分析。

Background: Workers’ absence due to health related problems has been an issue of concern in many European countries. Many studies indicated that, other than workers’ health status, factors that influence the extent of sickness absence include individual socio-demographic characteristics, work conditions, and social policy systems. Among individual factors, socioeconomic position (SEP) is important that influences not only worker’ health situation but also the accessibility to sickness absence benefit. Previous studies from other countries indicated that workers with lower SEP had poor health, but in contrast, those with higher SEP were more likely to have sickness absence. Up until now, few studies have been conducted in Taiwan to explore this issue.

Objectives: This study aimed to investigate the prevalence of sickness absence and its association with health situation and socioeconomic position among employees in Taiwan.

Methods: We analyzed data from a national survey of 9,503 male and 7,769 female employees aged 25~65 years in 2010. Information with regard to socioeconomic position (employment grade and education level), health situation, age, family workload, work conditions, psychosocial hazards at work and sickness absence was obtained by a standardized questionnaire.

Results: The results showed that 26.72% male and 31.23% female employees had been absent from work due to health-related problems. Findings from regression models indicated that workers with poor health were more likely to have sickness absence, and the duration of sickness absence was also longer. In male workers, skilled manual workers had a higher risk for sickness absence (OR=1.21) than low-skilled manual workers, after controlling for health status and other factors. While in female workers, skilled non-manual workers had a higher risk for sickness absence (OR=1.19) than low-skilled manual workers. When using education as the indicator of SEP, we found that in men, as compared with workers with lowest education level, those with high school degree (OR=0.79) and college degree (OR=0.83) had lower risk and shorter duration of sickness absence; but no significant association was found in female employees.

Conclusion and suggestion: Compare to non-skilled manual workers, skilled manual male workers and skilled non-manual female workers were at higher risk for sickness absence. This issue should be focused and managed. Future investigation should pay attention to the definition and measure of sickness absence, to aid in-depth evaluation and analyses on this topic.

口試委員會審定書
誌 謝
摘 要 I
Abstract III
目 錄 V
圖表目錄 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究重要性 4
第三節 研究目的 5
第二章 文獻回顧 6
第一節 因病缺勤的定義、測量與相關理論 6
第二節 因病缺勤相關因素研究：個人因素 16
第三節 因病缺勤相關因素研究：職場因素 20
第四節 小結 24
第三章 研究方法 25
第一節 研究架構與研究假說 25
第二節 研究資料與對象 26
第三節 研究變項 28
第四節 資料處理與統計方法 34
第四章 研究結果： 台灣社會經濟階層與因病缺勤之關係 35
第一節 研究對象之變項分布 35
第二節 社會經濟階層分組之變項分布 39
第三節 因病缺勤分組之變項分布 56
第四節 因病缺勤(有無)之 二元羅吉斯迴歸分析 64
第五節 因病缺勤(無、少日、多日)之 多元羅吉斯迴歸分析 76
第五章 討論 88
第一節 個人層面因素 88
第二節 職場層面因素 92
第三節 台灣因病缺勤情形 95
第四節 研究限制 96
第六章 研究結論與建議 98
第一節 研究結論 98
第二節 建議 101
參考文獻 103
附錄一、2010年「工作環境安全衛生狀況認知之調查」問卷 (部分節錄) 107
附錄二、研究變項操作型定義和處理方式 112
附錄三、1990年代各國對於因病缺勤所衍生的損失統計整理 116

英文部分
.
Absence from work. (2010). Dublin: European Foundation for the Improvement of Living and Working Conditions.
Ala-Mursula, L., Vahtera, J., Kivimäki, M., Kevin, M. V., & Pentti, J. (2002). Employee control over working times: associations with subjective health and sickness absences. . J Epidemiol Community Health, 56, 272-278.
Alexanderson, K. (1998). Sickness absence: a review of performed studies with focused on levels of exposure and theories utilized. Scand J Work Environ Health, 26, 241-249.
Andersen, L. L., Mortensen, O. S., Hansen, J. V., & Burr, H. (2011). A prospective cohort study on severe pain as a risk factor for long-term sickness absence in blue- and white-collar workers. Occup Environ Med, 68, 590-592.
Andrea, H., Beurskens, A. J. H. M., Metsemakers, J. F. M., van Amelsvoort, L. G. P. M., van den Brandt, P. A., & van Schayck, C. P. (2003). Health problems and psychosocial work environment as predictors of long term sickness absence in employees who visited the occupational physician and/or general practitioner in relation to work: a prospective study. Occup Environ Med, 60(295-300).
Ariëns, G. A. M., Bongers, P. M., Hoogendoorn, W. E., van der Wal, G., & van Mechelen, W. (2002). High physical and psychosocial load at work and sickness absence due to neck pain. Scand J Work Environ Health, 28, 222-231.
Bakker, A. B., Demerouti, E., de Boer, E., & Schaufeli, W. B. (2003). Job demands and job resources as predictors of absence duration and frequency. Journal of Vocational Behavior, 62, 341-356.
Barmby, T. A., Ercolani, M. G., & Treble, J. G. (2002). Sickness absence: an international comparison. The Economic Journal, 112(480), 315-331.
Bekker, M. H., Rutte, C. G., & van Rijswijk, K. (2009). Sickness absence: a gender-focused review. Psychol Health Med, 14, 405-418.
Benavides, F. G. (2006). Ill health, social protection, labour relations, and sickness absence. Occup Environ Med, 63(228-229).
Bergendorff, S. (2003). Sickness absence in Europe - a comparative study. Paper presented at the 4th International Research Conference on Social Security, Antwerp, Sweden.
Black, D. C., & Frost, D. (2011). Health at work –an independent review of sickness absence. London.
Black, D. C., Morris, J. N., Smith, C., Townsend, P., & Whitehead, M. (1988). Inequalities in Health: the Black Report and the Health Divide. London: Penguin.
d''Errico, A., & Costa, G. (2011). Socio-demographic and work-related risk factors for medium- and long-term sickness absence among Italian workers. European Journal of Public Health, 1-6.
Dekkers-Sanchez, P. M., Hoving, J. L., & Sluiter, J. K. (2008). Factors associated with long-termsick leave in sick-listed employees: a systematic review. Occup Environ Med 65, 153-157.
Elovainio, M., Kivimäki, M., & Vahtera, J. (2002). Organisational Justice: Evidence of a New Psychosocial Predictor of Health. Am J Public Health, 92, 105-108.
Faber, A., Sell, L., Hansen, J. V., Burr, H., Lund, T., Holtermann, A., & Søgaard, K. (2012). Does muscle strength predict future musculoskeletal disorders and sickness absence? Occup Med, 62, 41-46.
Fuhrer, R., Shipley, M. J., Chastang, J. F., Schmaus, A., Niedhammer, I., Stansfeld, S. A., . . . Marmot, M. G. (2002). Socioeconomic Position, Health, and Possible Explanations: A Tale of Two Cohorts. American Journal of Public Health, 92(8), 1290-12904.
Galobardes, B., Shaw, M., Lawlor, D. A., Smith, G. D., & Lynch, J. (2006). Indicators of Socioeconomic Position. In: . Methods in Social Epidemiology (Chapter 3), 47-85.
Gimeno, D., Benavides, F. G., Benach, J., & Amick III, B. C. (2004). Distribution of sickness absence in the European Union countries. Occup Environ Med, 61, 867-869.
Gründeman, R. W. M., & Vuuren, C. V. (1997). Preventing absenteeism at the workplace: European research report. Luxembourg: European Foundation for the Improvement of Living and Working Conditions, Office for Official Publications of the European Communities.
Hensing, G., Alexanderson, K., Allebeck, P., & Bjurulf, P. (1998). How to measure sickness absence? Literature review and suggestion of five basic measures. Scand J Public Health, 26(2), 133-144.
Hensing, G., Brage, S., Nygård, J. F., Sandanger, I., & Tellnes, G. (2000). Sickness absence with psychiatric disorders - an increased risk for marginalisation among men? Social Psychiatry and Psychiatric Epidemiology,, 35, 335-340.
Holtermann, A., Hansen, J. V., Burr, H., & Søgaard, K. (2010). Prognostic factors for long-term sickness absence among employees with neck-shoulder and low-back pain. Scand J Work Environ Health 36(1), 34-41.
Isaacs, S. L. (2004). Class-the ignored determinant of nation''s health. N Eng J Med, 351, 1137-1142.
Joensuu, M., & Lindström, K. (2003). Sickness absence and stress factors at work. Finland.
Kivimäki, M., Elovainio, M., & Vahtera, J. (2000). Workplace bullying and sickness absence in hospital staff. . Occupational and Environmental Medicine, 57, 656-660.
Kivimäki, M., Elovainio, M., Vahtera, J., & Ferrie, J. E. (2003). Organisational justice and health of employees: prospective cohort study. . Occup Environ Med, 60, 27-34.
Kivimäki, M., Head, J., Ferrie, J. E., Shipley, M. J., Vahtera, J., & Marmot, M. G. (2003). Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ, 327, 364-369.
Kivimäki, M., Vahtera, J., Koskenvuo, M., Uutela, A., & Pentti, J. (1998). Response of hostile individuals to stressful change in their working lives: test of a psychosocial vulnerability model. Psychological Medicine, 28, 903-913.
Kristensen, T. (1991). Sickness absence and work strain among Danish slaughterhouse workers: an analysis of absence from work regarded as coping behaviour. Social Science & Medicine, 32, 15-27.
Laaksonen, M., Martikainen, P., & Rahkonen, O. (2008). Explanations for gender differences in sickness absence: evidence from middle-aged municipal employees from Finland. Occup Environ Med, 65, 325-330.
Labriola, M., Holte, K. A., Christensen, K. B., Feveile, H., Alexanderson, K., & Lund, T. (2011). The attribution of work environment in explaining gender differences in long-term sickness absence: results from the prospective DREAM study. Occup Environ Med, 68, 703-705.
Laitinen-Krispijn, S., & Bijl, R. V. (2000). Mental disorders and employee sickness absence: the NEMESIS study. Social Psychiatry and Psychiatric Epidemiology, 35, 71-77.
Leineweber, C., Westerlund, H., Hagberg, J., Svedberg, P., & Alexanderson, K. (2012). Sickness presenteeism is more than an alternative to sickness absence: results from the population-based SLOSH study. Int Arch Occup Environ Health, published online only till 2012/3/20.
Marmot, M. G. (2006). Status syndrome: a challenge to medicine. JAMA, 295, 1304-1307.
Marmot, M. G., Feeney, A., Shipley, M., North, F., & Syme, S. L. (1995). Sickness absence as a measure of health status and functioning: from the UK Whitehall II study. Journal of Epidemiology and Community Health 49, 124-130.
Michie, S., & Williams, S. (2003). Reducing work related psychological ill health and sickness absence: a systematic literature review. Occup Environ Med, 60, 3-9.
Muijzer, A., Geertzen, J. H., de Boer, W. E., Groothoff, J. W., & Brouwer, S. (2012). Identifying factors relevant in the assessment of return-to-work efforts in employees on long-term sickness absence due to chronic low back pain: a focus group study. BMC Public Health 12, 77-87.
Niedhammer, I., Bugel, I., Goldberg, M., Leclerc, A., & Guéguen, A. (1998). Psychosocial factors at work and sickness absence in the Gazel cohort: a prospective study. Occupational and Environmental Medicine, 55, 735-741.
North, F., Syme, S. L., Feeney, A., Head, J., Shipley, M. J., & Marmot, M. G. (1993). Explaining socio-economic differences in sickness absence: The Whitehall study. British Medical Journal, 306, 361-366.
Palmer, K. T., Harris, E. C., Linaker, C., Barker, M., Lawrence, W., Cooper, C., & Coggon, D. (2012). Effectiveness of community- and workplace-based interventions to manage musculoskeletal-related sickness absence and job loss: a systematic review. Rheumatology, 51, 230-242.
Rasmussen, B. K., Jensen, R., & Olesen, J. (1992). Impact of headache on sickness absence and utilisation of medical services: a Danish population study. Journal of Epidemiology and Community Health, 46, 443-446.
Smebu, L., Bruusgaard, D., & Claussen, B. (2009). Sickness absence: could gender divide be explained by occupation, income, mental distress and health? Scand J Public Health, 37, 674-681.
Stansfeld, S. A., Feeney, A., Head, J., Canner, R., North, F., & Marmot, M. G. (1995). Sickness absence for psychiatric illness: the Whitehall II study. Soc Sci Med, 40(2), 189-197.
Stansfeld, S. A., Fuhrer, R., & Head, J. (2011). Impact of common mental disorders on sickness absence in an occupational cohort study. Occup Environ Med 68, 408-413.
Tennant, C. (2001). Work-related stress and depressive disorders. Journal of Psychosomatic Research, 51, 697-704.
Thompson, L., Griffits, A., & Davison, S. (2000). Employee absence, age and tenure: a study of nonlinear effects and triviate models. Work & Stress, 14, 16-34.
Vaez, M., Rylander, G., Nygren, A. k., A°sberg, M., & Alexanderson, K. (2007). Sickness absence and disability pension in a cohort of employees initially on long-term sick leave due to psychiatric disorders in Sweden. Soc Psychiatry Psychiatr Epidemiol 42, 381-388.
Vahtera, J., Kivimäki, M., & Pentti, J. (1997). Effect of organisational downsizing on health of employees. Lancet, 350, 1124-1128.
Vahtera, J., Kivimäki, M., Pentti, J., & Theorell, T. (2000). Effect of change in the psychosocial work environment on sickness absence: a seven year follow up of initially healthy employees. J Epidemiol Community Health, 54, 484-493.
Vahtera, J., Pentti, J., & Uutela, A. (1996). The effect of objective job demands on registered sickness absence spells; do personal, social and job-related resources act as moderators? Work & Stress, 10, 286-308.
Voss, M., Floderus, B., & Diderichsen, F. (2001). Physical, psychosocial, and organisational factors relative to sickness absence: a study based on Sweden post. Occupational and Environmental Medicine, 58, 178-184.
Whitaker, S. C. (2001). The management of sickness absence. Occup Environ Med, 58, 420-424.
Wikman, A., Marklund, S., & Alexanderson, K. (2005). Illness, disease, and sickness absence: an empirical test of differences between concepts of ill health. J Epidemiol Community Health, 59, 450-454.


中文部分

王佳雯. (2010). 社會心理危害、不安定僱用模式與受雇者之健康 碩士, 國立臺灣大學, 臺灣台北.
王佳雯, 鄭雅文, 李諭昇, & 徐儆暉. (2010). 職場社會心理危害調查監測制度之國際概況. 台灣衛誌, 29(6), 551-560.
王佳雯, 鄭雅文, & 徐儆暉. (2011). 不安定僱用模式與受僱者健康之相關. 台灣衛誌, 30(3), 217-227.
李佩蓉. (2008). 「就業保障」、「職場正義」與受僱者疲勞：量表信效度分析與調查研究. 碩士, 國立臺灣大學, 臺灣台北.
香港職業安全健康局. (2011). 綠十字：英國「因病缺勤制度」的獨立檢討. In 香港職業安全健康局 (Ed.), (Vol. Jul/Aug 2011, pp. 32-35). 香港.