NUMBER OF CASES OF SICKNESS AND LOSS OF TIME AND WAGES

Table I in the appendix represents a summary by months of the data secured in the survey. Among the 76,559 employees covered, 8,761 cases of sickness causing disability of three days to six months were reported. The total loss of working time on account of sickness among these employees was 84,665 days, and the wage loss was $321,815.75. The number of cases of sickness per thousand employed varied from 16.7 in July to 25.1 in January. For the six months the number of cases was 114.4 per thousand employed, or a monthly average of 19.1. The average loss of working time for all cases reported was 9.7 days and the average wage loss was $36.73.

A summary by sex of the results of the survey is presented in the table below. It will be noted that for men the average loss per case was 9.3 days and $40.61 in wages and for women the average loss per case was 10.3 days and $29.23 in wages. The fact that, because of the nature of the survey, no cases of disability of more than six months could be included, of course, reduces the average term of disability and average wage loss.

Cases were classified by months according to the first day of disability. Consequently the number of cases of the longer disabilities was higher in the early months of the period than in the later months, and the monthly range in average loss of working time and wages per case is not of great significance. For instance, a factory in which the records of sickness were kept for the last six months of 1919 might report a disability started on July first and continued for six months, but no disability started December first could continue for more than one month within the period of the investigation.

The average per capita loss of working time caused by sickness involving disability of three days to six months was 1.1 days for the six months of this survey. The average per capita wage loss was $4.29. It is not possible from this to draw a definite conclusion as to the annual per capita loss of time or wages. The annual loss undoubtedly would be greater than double the figure given above for six months, as it is usually the case that the prevalence of respiratory diseases and epidemics of the late winter and early spring make the amount of sickness for the first half of the year greater than the amount for the last half, but how much greater cannot be stated definitely. A record of "Sickness and Absenteeism during 1919 in a Large Industrial Establishment," published by the United States Public Health Service* shows 1.87 per cent loss of time on account of sickness for the first six months and 1.70 per cent for the last six months. In this case the loss of time was 10 per cent higher for the first half of the year than for the second half. The death rate for New York State outside of New York City shows a considerably greater variation between the first and last halves of the year. In 1920 the average death rate for the first six months was 33 per cent higher than for the last six months. The average death rate for the years 1913-1917, however, was only 13 per cent higher for the first half of the year.

Assuming that the amount of sickness is normally 10 per cent greater the first half of the year-a sufficiently low estimate, certainly the annual per capita loss of time for employees covered by this survey on account of sickness of three days to six months duration would be 213 days.

The chief reason for the difference between this estimate and estimates commonly given of 5 to 9 days disability is the fact that no disabilities of more than six months or under three days were included. Persons more or less permanently disabled through accident, disease or advanced years no doubt did not appear on the time records and were consequently not reported among the disabled, since only persons actually employed at the time of the investigation were included in this survey.

Other factors in the disparity between the results of this and other surveys of sickness are the facts that loss of working time only was reported the average per capita amount of disability caused by sickness would be greater by one-sixth if Sundays were included — that accidents were excluded, and that male employees constituted approxi

Public Health Reports, September 10, 1920, Vol. 35, No. 37, pp. 21-43.

† Monthly Vital Statistics Review, New York State Department of Health, February, 1921, Vol. 1, No. 12.

In this

mately three-fourths of the employees covered by the survey. survey the sickness rate, both as to number of cases per thousand employed and as to average per capita loss of time, was more than 50 per cent greater for women than for men (101 cases of sickness per thousand male employees in six months, as compared with 154 cases per thousand female employees; and 0.9 working days loss for each male employee, as compared with 1.6 days loss for each female employee). Consequently, for an equal number of women and men the combined rate would be more than 10 per cent greater than the combined rate resulting from this survey. Whereas sickness surveys have usually covered an approximately equal number of males and females, the actual ratio employed in factories of the State outside of New York City is approximately 3 to 1-the ratio covered by this

survey.

The sickness record by general industry groups is shown in Table II. The stone, clay and glass products industry group shows the highest per capita loss of time on account of sickness, the rate being 1.8 working days for the six months. Leather, canvas and rubber goods and chemicals follow with a per capita loss of 1.2 days, the metal industries and the "other industries" group show a loss of 1.1 days, and wood manufactures, paper goods and printing, and textiles show the lowest rate, 0.9 days.

DISEASE OR CONDITION CAUSING DISABILITY

The importance of various diseases or conditions, both as to number of cases and as to the amount of disability and loss of wages resulting, is shown in Table III. The International List of Causes of Death, with some modifications, was used in classifying the causes of disability.

Diseases of the respiratory system constitute the largest group in number of cases. The second largest group numerically was diseases of the digestive system, with 25 per cent of all cases. The general disease group was of third importance numerically.

A few allied diseases — influenza and grippe, "colds" and bronchitis, and tonsilitis and other diseases of the throat-made up 45 per cent of all cases of disability reported and were responsible for 34 per cent or over one-third of the total loss of time caused by sickness.

The loss in working time caused by various diseases is a better measure of their importance, however. Diseases of the digestive system again represent 25 per cent of the total, and were of first importance, measured by the loss of working time involved. Twentyfour per cent of the total loss of time was caused by respiratory diseases

and 22 per cent by general diseases. As might be expected, the distribution of the total wage loss conforms quite closely to the distribution of the loss of time.

Some variation appears in the relative importance of the various diseases and conditions among male and female factory workers. From Table IV it appears that diseases of the nervous system, of the genitourinary system, and, to a lesser extent, of the respiratory system and of the digestive system were of greater importance for women than for men, both numerically and as to the loss of working time. The general diseases, especially influenza and grippe and rheumatism, diseases of the circulatory system, diseases of the skin, and diseases of the organs of locomotion were more prevalent among men than among

women.

The numerical distribution of cases of sickness by disease or condition is shown in Table V and the percentage distribution is shown in Table VI. The percentage table shows much more clearly than the tabulation of the number of cases the trend of the various diseases during the latter part of the year. Respiratory diseases, it will be noted, are of least importance numerically in July, but each successive month shows a larger proportion of such diseases. January shows a considerable reduction, but this was due to the much greater prevalence of influenza and grippe, which are classified with the general diseases. Diseases of the digestive system show just as plain a tendency to diminish from July to January. Diseases of the nervous system appear to be more numerous in the summer months than in the later months. The trend in the other main groups is not so plain. The general disease group shows a rising trend, but this is due to the increasing number of cases of influenza and grippe.

DURATION OF DISABILITY

The duration of disability caused by the various diseases is shown in Table VII. Of couse this includes, in some cases, a period greater than the actual duration of the disease. In other cases the length of time an employee remained away from work no doubt was less than the full duration of the disease. Another fact to be considered in connection with the term of disability shown is that, especially in the case of diseases that are normally of long duration, only part of the term of disability fell within the period covered by the investigation. For instance, if a person were absent on account of sickness from December first to February first, only the part of the absence that occurred in December would be reported.

The number of cases of sickness, combining all diseases or conditions, decreases rapidly as the term of disability becomes longer. There were 1,455 cases of sickness involving 3 days' disability and only 273 cases involving 10 days' disability. The figures presented in Table VIII show a very large number of 6-day cases, as compared with 5-day and 7-day cases. This is partly due to the fact that not only all cases of disability of 7 calendar days, but probably one-seventh of the 8 calendar day disabilities - those that included two Sundayswould also result in 6 days' absence from work. The chief reason,

however, seems to be the tendency to remain away from work an even week. It is probably true that some persons remain away from work a full week who are able to return a day earlier, and that some persons return to work at the beginning of a new week who could well remain at home a day longer.

Sixty per cent of the total number of cases reported were of not more than 6 days' duration, 80 per cent involved disability of 11 days or less, and only 10 per cent involved disability of more than 19 working days. Again it must be kept in mind that only a part of some of the longer disabilities fell within the period of the survey. Consequently the longer durations appear to be of less frequency and the shorter durations appear to be of greater frequency than their actual

occurrence.

The relative importance of sickness of different durations is better measured by the amount of time loss involved. The actual loss in working days caused by sickness of specified durations is also presented in Table VIII. With a few exceptions the total time loss resulting from sickness of different durations diminishes steadily as the period of disability becomes greater. For instance, the loss of working time. caused by 5-day cases is 6 per cent of the total loss for all duration, whereas the loss caused by 10-day cases is 3 per cent of the total. This tendency of the time loss caused by disability of different durations to vary inversely with the length of the period of disability, of course, is not nearly as marked as the tendency of the number of cases reported to vary inversely with the duration of disability.

Sickness of brief duration is of far less importance in the loss of time and wages than in the number of cases. Sickness causing disability of 3 to 6 days, which constituted 60 per cent of the total number of cases reported, involved only 26 per cent of the total time loss. More than half of the total loss of time and wages was caused by sickness lasting more than two weeks.