Chronic diseases in the working population -- especially cancer -- are major contributors to missed work time and lost productivity, according to a major study published in the March Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

Dr. Ronald Kessler of Harvard Medical School and coauthors believe that major shifts in insurance policies are needed to address the impact of chronic diseases in the workplace, estimated to account for more 2.5 billion missed work days or "work cutback" days per year.

The study included 2,074 respondents, aged 24 to 54 years, from the MacArthur Foundation Midlife Development in the United States (MIDUS) Survey.

About 22 percent of respondents reported at least one day in the past month in which they missed work or cut back on work because of a chronic illness.

This amounted to an average 1.5 days per month across all respondents, or 6.7 days per month for those reporting any missed time.

Generalized to the U.S. population in the age range studied, the findings suggested that chronic illnesses cause more than 2.5 billion illness-related work loss or work cutback days per year.

Although other chronic diseases were more common, cancer had the greatest impact on missed work time.

Two-thirds of respondents with cancer reported work loss or work cutback days in the past month, with an average of 16 such days.

Respondents with ulcers, depression and panic disorder also had high rates of work impairment; those with heart disease or high blood pressure had a high number of impaired work days.

Certain combinations of diseases -- such as arthritis, ulcers, mental disorders and substance dependence -- led to higher than expected levels of impairment.

"The enormous magnitude of the work impairment associated with the chronic conditions studied here should be taken into consideration in the current debate on universal health insurance," wrote Kessler and colleagues. "Those losses in productivity might be reduced through policies to increase recognition of currently untreated chronic diseases while improving treatment for other patients. Because cancer accounts for so many impaired work days, it is a logical first target for such efforts."

The researchers also urged further studies to examine the impact of work cutback days.

Most previous studies have ignored this problem -- sometimes called "presenteeism" -- in which workers are present but have reduced productivity due to illness.

The hidden costs associated with cutback days may make them an even more challenging problem than missed work days, noted researchers.

by Virginia Sutcliffe