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External validation of two prediction models identifying employees at risk of high sickness absence cohort study with 1-year follow-up.doc

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External validation of two prediction models identifying employees at risk of high sickness absence cohort study with 1-year follow-up

Roelenetal.BMCPublicHealth2013,13:105 /1471-2458/13/105 RESEARCH ARTICLE OpenAccess Externalvalidationoftwopredictionmodels identifyingemployeesatriskofhighsickness absence:cohortstudywith1-yearfollow-up CornéAMRoelen1,2,3*,UteBültmann3,WillemvanRhenen1,4,JacJLvanderKlink3,JosWRTwisk2 andMartijnWHeymans2 Abstract Background:Twomodelsincludingage,self-ratedhealth(SRH)andpriorsicknessabsence(SA)werefoundto predicthighSAinhealthcareworkers.Thepresentstudyexternallyvalidatedthesepredictionmodelsina populationofofficeworkersandinvestigatedtheeffectofaddinggenderasapredictor. Methods:SRHwasassessedatbaselineinaconveniencesampleofofficeworkers.Age,genderandpriorSAwere retrievedfromanoccupationalhealthserviceregister.Twopre-definedpredictionmodelswereexternallyvalidated: amodelidentifyingemployeeswithhigh(i.e.≥30)SAdaysandamodelidentifyingemployeeswithhigh(i.e.≥3) SAepisodesduring1-yearfollow-up.Calibrationwasinvestigatedbyplottingthepredictedandobserved probabilitiesandcalculatingthecalibrationslope.Discriminationwasexaminedbyreceiveroperatingcharacteristic (ROC)analysisandtheareaundertheROC-curve(AUC). Results:Atotalof593officeworkershadcompletedataandwereeligibleforanalysis.AlthoughtheSAdays modelshowedacceptablecalibration(slope=0.89),itpoorlydiscriminatedofficeworkerswithhighSAdaysfrom thosewithouthighSAdays(AUC=0.65;95%CI0.58–0.71).TheSAepisodesmodelshowedacceptable discrimination(AUC=0.76,95%CI0.70–0.82)andcalibration(slope=0.96).Theprognosticperformanceofthe predictionmodelsdidnotimproveinthepopulationofofficeworkersafteraddinggender. Conclusion:TheSAepisodesmodelaccuratelypredictedtheriskofhighSAepisodesinofficeworkers,butneeds furthermultisitevalidationandrequiresasimplerpresentationformatbeforeitcanbeusedtoselecthigh-risk employeesforinterventionstopreventorreduceSA. Keywords:Absenteeism,Forecasting,Generalization,Officeworkers,Regressionprognostics,Sickleave,Transportability Background still at work, but at high risk of long-term SA. The im- Sicknessabsence(S