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The purpose of this paper is to investigate the impact of changes of medical condition burden index (MCBI) and stress on absenteeism and discuss implications for policy/program design.

Sample: US utility employees that participated in Health Risk Appraisals (HRA) during 2009 and 2010 (n=3,711). Methods: the MCBI was created by summing number of medical conditions. Absenteeism was measured from administrative records. Change in MCBI and stress and impact on absenteeism was assessed according to incremental change, by low/high categorizations, and by using multivariate regression.

Incrementally, greater changes in MCBI or stress generally resulted in corresponding absenteeism change. For both MCBI and stress, high categories were associated with greater absenteeism compared to those in low categories. Those remaining in the low MCBI category decreased absenteeism (−0.10 days/year; p=0.01). Changes from low to high MCBI resulted in increased absenteeism (+0.12 days/year; p=0.04. Changes in stress from low to high or from high to low categories resulted in concurrent changes in absenteeism (+0.21 days/year; p=0.04 and −0.31 days/year; p=0.01, respectively). Regression analyses indicated the interaction between stress and MCBI as a significant contributor to absenteeism change.

Conclusions: MCBI, stress and their interaction appear to be direct determinants of absenteeism. Companies should consider both physical and emotional health simultaneously in program interventions in order to reduce absenteeism.

Unlike most studies illustrating cross-sectional relationships, this study shows how changes in stress and medical conditions relate to changes in absenteeism. The interaction between MCBI and stress in this context is also a novel addition.