BMJ  2004;328:555 (6 March), doi:10.1136/bmj.37972.496262.0D (published 23
February 2004)
http://bmj.bmjjournals.com/cgi/content/abstract/328/7439/555

Paper

Organisational downsizing, sickness absence,
and mortality: 10-town prospective cohort
study

Jussi Vahtera, senior researcher1, Mika Kivimäki, professor1, Jaana
Pentti, statistician1, Anne Linna, research fellow1, Marianna Virtanen,
research fellow1, Pekka Virtanen, senior lecturer2, Jane E Ferrie, senior
research fellow3

1 Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA,
FIN-00250 Helsinki,
Finland, 2 University of Tampere, Medical School, FIN-33014 University of
Tampere,
Finland, 3 International Centre for Health and Society, Department of
Epidemiology and
Public Health, University College London Medical School, London WC1E 6BT

Correspondence to: J Vahtera, Finnish Institute of Occupational Health,
Hämeenkatu 10,
FIN-20500 Turku, Finland [log in to unmask]

Objective To examine whether downsizing, the reduction of personnel in
organisations, is a predictor of increased sickness absence and mortality
among
employees.

Design Prospective cohort study over 7.5 years of employees grouped into
categories on the basis of reductions of personnel
in their occupation and workplace: no downsizing (< 8% reduction), minor
downsizing (8-18%), and major downsizing (>
18%).

Setting Four towns in Finland.

Participants 5909 male and 16 521 female municipal employees, aged 19-62
years, who kept their jobs.

Main outcome measures Annual sickness absence rate based on employers'
records before and after downsizing by
employment contract; all cause and cause specific mortality obtained from
the national mortality register.

Results Major downsizing was associated with an increase in sickness
absence (P for trend < 0.001) in permanent employees
but not in temporary employees. The extent of downsizing was also
associated with cardiovascular deaths (P for trend < 0.01)
but not with deaths from other causes. Cardiovascular mortality was 2.0
(95% confidence interval 1.0 to 3.9) times higher after
major downsizing than after no downsizing. Splitting the follow up period
into two halves showed a 5.1 (1.4 to 19.3) times
increase in cardiovascular mortality for major downsizing during the first
four years after downsizing. The corresponding hazard
ratio was 1.4 (0.6 to 3.1) during the second half of follow up.

Conclusion Organisational downsizing may increase sickness absence and the
risk of death from cardiovascular disease in
employees who keep their jobs.

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