Safety climate at work and risk of long-term sickness absence: Prospective cohort with register follow-up among 63,500 workers

Objective: Safety climate at work is a known predictor of accidents and may therefore have consequences for absenteeism. This study investigates the relevance of safety climate at work as a predictor for the risk of long-term sickness absence (LTSA).Methods: We followed 63,500 employees of the general working population in Denmark, without prior LTSA, in four biannual national cohort surveys in the period 2012-2018 for two years in a national register of social transfer payments. Weighted Cox-regression was used to control for age, gender, survey year, education, lifestyle, psychosocial work factors, occupational group, and depressive symptoms. We determined the prospective as-sociation of the number of safety climate problems (0-5) with the risk of LTSA of six or more week's absence.Results: During follow-up, 5,743 employees developed LTSA (weighted percentage: 8.6%). Compared with in-dividuals not reporting any safety climate problems, those reporting 1, 2, 3 and 4-5 problems experienced significantly increased risk of LTSA with hazard ratios of 1.13, 1.18, 1.20 and 1.44, respectively. Sensitivity analyses, including only those with physically demanding work and stratifying for gender, showed the same tendencies, although only reaching statistical significance for 4-5 safety climate problems. Interaction analyses showed that gender, age and education, did not modify the association between number of safety climate problems and risk of LTSA.Conclusion: The presence of safety climate problems at work increases the risk of LTSA in the general working population. The presence of safety climate problems can be considered a proactive indicator that actions need to be taken to improve safety, health, and wellbeing in the workplace.