PURPOSE: Sickness presenteeism, defined as 'going to work despite judging that one should have reported in sick', is usually considered to be a complementary alternative to sickness absence. Nonetheless, several studies have reported a positive association between sickness absence and sickness presenteeism. The aim of the present study was to investigate whether the contemporaneous positive association between sickness absence and sickness presenteeism can be explained by illness, work incapacity, and/or work environment.

METHODS: A cross-sectional study based on answers to a comprehensive questionnaire from 8,304 working women and men, those in the second wave of the nationally representative Swedish Longitudinal Occupational Survey of Health. Logistic regression was used to investigate the association between sickness presenteeism and sickness absence.

RESULTS: Sickness absence was strongly associated with sickness presenteeism. Sickness absence of 1-7 days during a 12-month period more than doubled the odds of also having sickness presenteeism of more than 8 days during the same 12-month period (OR = 2.11; 95% CI: 1.79-2.49). Adjusting for age and sex did not attenuate the association; further adjustment for work environment, self-rated health, chronic diseases, and work capacity reduced the odds somewhat, but they remained highly significant (OR = 1.88; 95% CI: 1.56-2.25).

CONCLUSIONS: The results suggest that sickness presenteeism is not, as earlier hypothesised, just an alternative to sickness absence, given a certain level of health or work incapacity. Other, so far unknown explanations for both sickness absence and sickness presenteeism must be sought.