Has the Spanish economic crisis affected the duration of sickness absence episodes? Guillermo Murcia L  opez a, * , Jordi Delcl  os Clanchet a, b, c ,M  onica Ubalde L  opez a, b, d , Eva Calvo Bonacho e , Fernando G. Benavides a, b, d a CISAL-Center for Research in Occupational Health, Universitat Pompeu-Fabra, Doctor Aiguader 88, 08003 Barcelona, Barcelona, Spain b CIBERESP, CIBER in Epidemiology and Public Health, Av. Monforte de Lemos, 3-5. Pabell on 11. Planta 0, 28029 Madrid, Spain c Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, P.O. Box 20186, Houston, TX 77225-0186, USA d IMIM (Hospital del Mar Medical Research Institute), Carrer del Dr. Aiguader, 88, 08003 Barcelona, Spain e Ibermutuamur, Mutua de Accidentes de Trabajo y Enfermedades Profesionales de la Seguridad Social 274, Calle Ramírez de Arellano, 27, 28043 Madrid, Spain article info Article history: Received 8 December 2015 Received in revised form 1 May 2016 Accepted 4 May 2016 Available online 7 May 2016 Keywords: Non-work related sickness absence Spain Economic crisis Occupational health abstract The global economic crisis has had particularly intense effects on the Spanish labor market. We inves- tigated whether the duration of non-work related sickness absence (SA) episodes in salaried workers had experienced any changes before and after the crisis started. This was a repeated cross-sectional analysis conducted in a dynamic cohort in 2006 and 2010. Database was provided by eight mutual insurance companies, covering 983,108 workers and 451,801 SA episodes. Descriptive analysis and crude, bivariate and multivariate analyses using Cox proportional hazards modeling were performed, to quantify the changes in duration of SA episodes between 2006 and 2010, stratified by sex. There was a higher number of episodes in 2010 for both sexes, but especially for women. Unadjusted median duration in men was similar for both years, while for women it was shorter in 2010. Final multivariate models show a greater risk of longer episode duration for men in 2010 (HR 0.95; 95% CI, 0.95e0.95), but a shorter one for women (HR 1.07; 95% CI,1.07e1.07). Once the economic crisis started affecting the Spanish labor market, the number of SA episodes in women equalized with those in men. There was a decrease of episodes in the youngest age groups, in the construction and in temporary contracts. The relative ranking of leading diagnoses was similar in both years with an increase in infectious, nervous system and respiratory diseases and in mental disorder episodes for both sexes, but especially for women. The risk of longer episode duration was greater in 2010 among men, but smaller in women. © 2016 Published by Elsevier Ltd. 1. Background Spain is still suffering the economic shockwaves caused by the Global Financial Crisis of 2008. As of late 2015, the unemployment rate stands at 21.8% with those under 25 years of age especially affected and suffering an unemployment rate of 46.6% (Instituto Nacional de Estadística, 2015a). A prolonged downward trend of the Spanish Global Domestic Product (GDP) during this period stopped in early 2014, but so far it has only showed tenuous signs of recovery (Instituto Nacional de Estadística, 2015b). Scientific literature published until now suggests that economic crises have diverse impacts on public and occupational health (Suhrcke and Stuckler, 2012). Stuckler et al. found that periods of economic recession correlate with a rise in deaths due to alcohol- abuse and suicide, and a decrease in those due to road traffic ac- cidents or drug abuse (Stuckler et al., 2009). Burstr€ om et al., focused on the delayed effects of the economic crisis in Sweden in the 1990s and the public response to them. They found that the number of episodes of limiting longstanding illnesses or disabilities rose during the studied period, particularly among manual female workers (Burstr€ om et al., 2012). * Corresponding author. Permanent address: c/Guardia Civil, nº 20, Esc 4 Pta 38, Valencia, CP 46020, Spain. E-mail addresses: guillermo.murcia@upf.edu (G. Murcia L opez), george.delclos@ uth.tmc.edu (J. Delcl os Clanchet), monica.ubalde@upf.edu (M. Ubalde L opez), evacalvo@ibermutuamur.es (E. Calvo Bonacho), fernando.benavides@upf.edu (F.G. Benavides). Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2016.05.009 0277-9536/© 2016 Published by Elsevier Ltd. Social Science & Medicine 160 (2016) 29e34