The impact of pain on labor force participation, absenteeism and presenteeism in the European Union

Figures & data

Table 1.  Reported pain severity and frequency of pain.

Pain dimension	Respondents five EU countries*	Distribution (%)
Pain level
Severe	11,318,103	22.8
Moderate	29,439,982	59.2
Mild	8,970,445	18.0
Pain frequency
Daily	21,703,485	43.6
2–6 times a week	14,510,928	29.2
Weekly or less	13,514,117	27.2
Pain level and frequency
Severe daily pain	8,506,068	17.1
Severe and 4–6 times per week	969,348	2.0
Severe and 2–3 times per week	734,408	1.5
Severe and weekly or less	1,108,279	2.2
Moderate daily pain	11,746,535	23.6
Moderate and 4–6 times a week	4,145,306	8.3
Moderate and 2–3 times per week	6,047,471	12.2
Moderate and weekly or less	7,500,670	15.1
Mild daily pain	1,450,882	2.9
Mild and 2–6 times per week	2,614,395	5.3
Mild and weekly or less	4,905,168	9.9

*UK, France, Spain, Germany, Italy.

Source: National Health and Wellness Survey 2008.

Table 2.  Labor force status of persons reporting pain by pain severity and no pain.

Labor force status	Persons reporting no pain (%)	Persons reporting pain (%)	Persons reporting mild pain (%)	Persons reporting moderate pain (%)	Persons reporting severe pain (%)
Employed full-time	44.52	34.85	47.39	34.44	25.98
Employed part-time	6.11	5.56	7.25	5.72	3.79
Self-employed	9.80	10.58	10.75	10.83	9.81
Unemployed	4.03	4.93	4.05	5.15	5.08
Not in labor force	35.54	44.07	30.56	43.86	55.33
Total	100.00	100.00	100.00	100.00	100.00

Source: National Health and Wellness Survey 2008.

Table 3.  Workplace productivity and activity impairment scale: impact of health problems on absenteeism in the past 7 days.

Absenteeism: percentage of worktime lost	All persons (%)	Persons reporting ‘no pain’ (%)	Persons reporting ‘pain’ (%)
0–9 (Health problems had  no effect on my work)	90.15	91.90	82.15
10–19	2.28	1.90	4.02
20–29	1.69	1.35	3.27
30–39	0.63	0.51	1.19
40–49	0.62	0.51	1.13
50–59	1.26	1.28	1.18
60–69	0.45	0.37	0.82
70–79	0.23	0.22	0.28
80–89	0.15	0.14	0.19
90–99	0.11	0.09	0.18
Health problems completely prevented me from working	2.41	1.72	5.58

Source: National Health and Wellness Survey, 2008.

Table 4.  Workplace productivity and activity impairment scale: impact of health problems on presenteeism in the past 7 days.

Presenteeism responses	All persons (%)	Persons reporting ‘no pain’ (%)	Persons reporting ‘pain’ (%)
0 (Health problems had  no effect on my work)	52.03	56.22	32.08
1	12.94	12.95	12.84
2	10.13	9.39	13.66
3	6.66	5.90	10.27
4	3.92	3.38	6.52
5	5.51	4.97	8.09
6	4.06	3.53	6.58
7	2.73	2.04	5.99
8	0.97	0.71	2.21
9	0.41	0.36	0.66
10 (Health problems completely prevented me from working)	0.63	0.53	1.10

Source: National Health and Wellness Survey, 2008.

Table 5.  Distribution of independent variables.

Independent variables	No pain (%)	Pain (%)
Socio-demographic variables
Age: 20–39 years	38.0	28.9
Age: 4–59 years	35.2	41.7
Age: 60 years and older	26.8	29.4
Gender: male	50.9	39.4
Gender: female	49.1	60.7
Education: university or higher	32.1	25.1
Education: high school completed	50.7	49.2
Education: other	17.2	25.7
Income: under €20,000	25.6	33.1
Income: €20,000–39,999	35.0	34.0
Income: €40,000 and above	23.3	18.5
Income reporting declined	16.1	14.5
Health risk behaviors
BMI: underweight	2.6	2.3
BMI: normal weight	39.9	31.3
BMI: overweight	37.3	35.8
BMI: obese	16.3	24.1
BMI: morbidly obese	1.6	4.5
BMI: reporting declined	2.2	2.0
Current smoker	28.5	32.8
Alcohol user	60.4	54.8
Morbidity/comorbidity status
Charlson Comorbidity Index (SD)	0.301 (0.903)	0.603 (1.252)

SD, standard deviation.

Source: National Health and Wellness Survey, 2008.

Table 6.  Labor force participation logit regressions.

Regression model	Binary logit model I			Binary logit model II
Independent variables	Odds ratio	p > |z|	95% confidence interval	Odds ratio	p > |z|	95% confidence interval
Pain level reported in last month*
Severe	0.443	0.00	0.399–0.491
Moderate	0.800	0.00	0.740–0.865
Mild	1.126	0.10	0.976–1.299
Pain level and frequency*
Severe daily pain				0.350	0.00	0.310–0.395
Severe pain and 4–6 times a week				0.678	0.02	0.486–0.945
Severe pain and 2–3 times a week				1.166	0.48	0.758–1.793
Severe pain and weekly or less				0.839	0.27	0.615–1.144
Moderate daily pain				0.612	0.00	0.536–0.697
Moderate pain and 4–6 times a week				0.770	0.01	0.637–0.931
Moderate pain and 2–3 times week				0.918	0.25	0.794–1.062
Moderate pain and weekly or less				1.069	0.34	0.933–1.225
Mild daily pain				0.918	0.66	0.627–1.346
Mild pain and 2–6 times a week				1.326	0.06	0.992–1.772
Mild pain and weekly or less				1.097	0.28	0.926–1.299
Socio-demographic variables
Age: 40–59 years^1	1.355	0.00	1.281–1.432	1.388	0.00	1.312–1.468
Age: 60 years and older^1	0.053	0.00	0.049–0.058	0.055	0.00	0.050–0.059
Gender: male^2	1.652	0.00	1.561–1.748	1.651	0.00	1.560–1.747
Education: high school completed^3	0.922	0.03	0.856–0.994	0.923	0.03	0.856–0.994
Education: university or higher^3	1.857	0.00	1.714–2.011	1.861	0.00	1.718–2.015
Country: UK^5	0.721	0.00	0.671–0.775	0.731	0.00	0.680–0.787
Country: France^5	0.726	0.00	0.681–0.775	0.729	0.00	0.684–0.779
Country: Spain^5	1.096	0.12	0.977–1.230	1.105	0.09	0.985–1.240
Country: Italy^5	1.278	0.00	1.156–1.412	1.278	0.00	1.157–1.413
Health risk behaviors
BMI: underweight^6	0.766	0.00	0.661–0.886	0.763	0.00	0.659–0.884
BMI: overweight^6	1.123	0.00	1.053–1.198	1.125	0.00	1.055–1.201
BMI: obese^6	1.061	0.12	0.986–1.143	1.070	0.08	0.993–1.152
BMI: morbidly obese^6	0.816	0.01	0.706–0.944	0.836	0.02	0.722–0.967
BMI: reporting declined	0.841	0.02	0.730–0.968	0.842	0.02	0.731–0.970
Current smoker^7	1.340	0.00	1.264–1.420	1.338	0.00	1.262–1.418
Alcohol user^8	1.349	0.00	1.277–1.426	1.344	0.00	1.271–1.420
Morbidity/comorbidity status
Charlson Comorbidity Index	0.922	0.00	0.890–0.954	0.925	0.00	0.895–0.957
n	53,052			53,052
Log pseudo likelihood	−27,964.5			−27896.7
Pseudo R^2	0.297			0.299

Reference categories: *no pain reported in last month; ¹age 18–39 years; ²females; ³not completed high school; ⁴income under €20,000; ⁵country: Germany; ⁶BMI normal weight; ⁷non-smoker; ⁸non-drinker.

Table 7.  Labor force participation multinomial logit regression: predicted relative probabilities for severe and moderate daily pain.

Labor force status	Multinomial logit model I			Multinomial logit model II
	Severe pain	Moderate pain	Mild pain	Severe daily pain	Moderate daily pain
Employed full-time
Pain	0.266	0.368	0.421	0.228	0.316
No pain	0.427	0.426	0.418	0.426	0.424
Employed part-time
Pain	0.043	0.065	0.077	0.035	0.054
No pain	0.068	0.066	0.066	0.068	0.067
Self-employed
Pain	0.090	0.105	0.119	0.081	0.099
No pain	0.109	0.108	0.108	0.109	0.109
Unemployed
Pain	0.038	0.044	0.037	0.035	0.044
No pain	0.038	0.038	0.038	0.038	0.038
Not in the labor force
Pain	0.564	0.418	0.345	0.621	0.486
No pain	0.359	0.362	0.370	0.359	0.363

Table 8.  Absenteeism ordered logit regression results.

Regression model	Ordered logit regression: model I			Ordered logit regression: model II
Independent variables	Odds ratio	p > |z|	95% confidence interval	Odds ratio	p > |z|	95% confidence interval
Pain reported in last month*
Mild	1.349	0.01	(1.073–1.695)
Moderate	1.901	0.00	(1.682–2.148)
Severe	5.979	0.00	(5.088–7.025)
Pain level and frequency*
Severe daily pain				8.429	0.00	(6.936–10.244)
Severe pain and 4–6 times a week				5.342	0.00	(3.299–8.651)
Severe pain and 2–3 times a week				2.746	0.00	(1.719–4.385)
Severe pain and weekly or less				1.780	0.03	(1.061–2.984)
Moderate daily pain				2.735	0.00	(2.252–3.322)
Moderate pain and 4–6 times a week				2.086	0.00	(1.590–2.736)
Moderate pain and 2–3 times week				1.960	0.00	(1.568–2.448)
Moderate pain and weekly or less				1.140	0.25	(0.913–1.425)
Mild daily pain				1.202	0.54	(0.671–2.153)
Mild pain and 2–6 times a week				1.728	0.01	(1.132–2.637)
Mild pain and weekly or less				1.207	0.20	(0.903–1.614)
Socio-demographic variables
Age: 40–59 years^1	0.862	0.00	(0.783–0.949)	0.833	0.00	(0.757–0.918)
Age: 60 years and older^1	0.702	0.01	(0.549–0.897)	0.663	0.00	(0.518–0.850)
Gender: male^2	0.893	0.02	(0.812–0.983)	0.898	0.03	(0.816–0.989)
Education: high school completed ^3	0.983	0.82	(0.849–1.139)	0.993	0.92	(0.858–1.149)
Education: university or higher^3	1.018	0.82	(0.879–1.178)	1.020	0.79	(0.881–1.181)
Income: €20,000–39,999^4	0.932	0.26	(0.824–1.054)	0.931	0.25	(0.823–1.053)
Income: €40,000 and above^4	0.972	0.68	(0.852–1.110)	0.981	0.78	(0.859–1.120)
Income: reporting declined^4	0.653	0.00	(0.550–0.774)	0.648	0.00	(0.546–0.770)
Country: UK^5	0.801	0.00	(0.703–0.911)	0.782	0.00	(0.686–0.891)
Country: France^5	0.809	0.00	(0.714–0.917)	0.794	0.00	(0.701–0.900)
Country: Spain^5	0.832	0.07	(0.685–1.011)	0.821	0.05	(0.676–0.998)
Country: Italy^5	1.036	0.66	(0.885–1.212)	1.027	0.74	(0.878–1.202)
Health risk behaviors
BMI: underweight^6	1.511	0.00	(1.178–1.939)	1.513	0.00	(1.179–1.942)
BMI: overweight^6	0.960	0.47	(0.861–1.071)	0.958	0.45	(0.859–1.069)
BMI: obese^6	1.091	0.19	(0.958–1.242)	1.080	0.25	(0.948–1.232)
BMI: morbidly obese^6	1.545	0.00	(1.161–2.056)	1.530	0.00	(1.146–2.043)
BMI: reporting declined^6	1.613	0.00	(1.175–2.214)	1.601	0.00	(1.165–2.201)
Current smoker^7	1.057	0.26	(0.960–1.164)	1.063	0.21	(0.965–1.171)
Alcohol user^8	0.916	0.07	(0.833–1.007)	0.918	0.08	(0.834–1.010)
Morbidity/comorbidity status
Charlson Comorbidity Index	1.240	0.00	(1.143–1.346)	1.232	0.00	(1.135–1.338)
Pseudo R^2 (MacFadden)	0.035			0.039
Log likelihood	−16436.6			−16376.8
n	29,626			29,626

Reference categories: *no pain reported in last month; ¹age 18–39 years; ²females; ³not completed high school; ⁴income under €20,000; ⁵country: Germany; ⁶BMI normal weight; ⁷non-smoker; ⁸non-drinker.

Table 9.  Presenteeism ordered logit regression results.

Regression model	Ordered logit regression: Model 1			Ordered logit regression: Model II
Independent variables	Odds ratio	p > |z|	95% confidence interval	Odds ratio	p > |z|	95% confidence interval
Pain reported in last month*
Mild	1.650	0.00	(1.464–1.860)
Moderate	2.577	0.00	(2.390–2.779)
Severe	5.518	0.00	(4.788–6.360)
Pain level and frequency*
Severe daily pain				7.319	0.00	(6.100–8.783)
Severe pain and 4–6 times a week				5.572	0.00	(3.896–7.969)
Severe pain and 2–3 times a week				4.703	0.00	(3.369–6.565)
Severe pain and weekly or less				2.215	0.00	(1.570–3.125)
Moderate daily pain				3.493	0.00	(3.058–3.990)
Moderate pain and 4– 6 times a week				3.049	0.00	(2.531–3.674)
Moderate pain and 2–3 times week				3.036	0.00	(2.650–3.477)
Moderate pain and weekly or less				1.646	0.00	(1.464–1.849)
Mild daily pain				1.879	0.00	(1.384–2.550)
Mild pain and 2–6 times a week				2.425	0.00	(1.928–3.049)
Mild pain and weekly or less				1.327	0.00	(1.141–1.544)
Socio-demographic variables
Age: 40–59 years^1	0.798	0.00	(0.755–0.843)	0.785	0.00	(0.743–0.830)
Age: 60 years and older^1	0.594	0.00	(0.522–0.675)	0.574	0.00	(0.504–0.653)
Gender: male^2	0.849	0.00	(0.804–0.896)	0.855	0.00	(0.810–0.903)
Education: high school completed ^3	0.982	0.65	(0.906–1.064)	0.992	0.85	(0.916–1.075)
Education: university or higher^3	1.118	0.01	(1.030–1.213)	1.124	0.00	(1.036–1.220)
Income: €20,000–39,999^4	0.930	0.04	(0.866–0.998)	0.932	0.05	(0.868–1.000)
Income: €40,000 and above^4	0.893	0.00	(0.826–0.966)	0.898	0.01	(0.831–0.970)
Income: reporting declined^4	0.865	0.00	(0.789–0.949)	0.868	0.00	(0.791–0.952)
Country: UK^5	0.825	0.00	(0.769–0.884)	0.812	0.00	(0.757–0.871)
Country: France^5	0.732	0.00	(0.683–0.783)	0.723	0.00	(0.675–0.774)
Country: Spain^5	0.859	0.00	(0.774–0.953)	0.855	0.00	(0.770–0.949)
Country: Italy^5	1.254	0.00	(1.150–1.367)	1.247	0.00	(1.144–1.360)
Health risk behaviors
BMI: underweight^6	1.287	0.00	(1.091–1.519)	1.277	0.00	(1.083–1.505)
BMI: overweight^6	0.967	0.28	(0.910–1.028)	0.963	0.23	(0.906–1.024)
BMI: obese^6	1.108	0.01	(1.030–1.193)	1.099	0.01	(1.021–1.183)
BMI: morbidly obese^6	1.530	0.00	(1.284–1.824)	1.510	0.00	(1.267–1.801)
BMI: reporting declined^6	1.134	0.14	(0.961–1.338)	1.128	0.15	(0.956–1.332)
Current smoker^7	1.008	0.77	(0.953–1.067)	1.010	0.74	(0.954–1.068)
Alcohol user^8	1.044	0.13	(0.987–1.104)	1.044	0.13	(0.987–1.104)
Morbidity/comorbidity status
Charlson Comorbidity Index	1.313	0.00	(1.237–1.393)	1.305	0.00	(1.229–1.385)
Pseudo R^2 (MacFadden)	0.026			0.028
Log likelihood	−51644.2			−51548.0
n	28,882			28,882

Note: Reference categories: *no pain reported in last month; ¹age 18–39 years; ²females; ³not completed high school; ⁴income under €20,000; ⁵country: Germany; ⁶BMI normal weight; ⁷non-smoker; ⁸non-drinker.