*4.3. Comorbidity and Sickness Absenteeism*

In general, sickness-related absenteeism is an outcome variable of several other variables within the work environment, in addition to external and individual factors. In this study, the main purpose was to assess the role of chronic diseases or problems in work absences.

The statistical analyses revealed that the CI that contemplates the presence of pathologies/chronic health conditions was highly significantly associated with the working days lost (r = 0.254, *p*-value = 0.01), therefore the number of days away from work increases with the increase in the CI score. This correlation was evidenced in other research involving civil servants. It is known that the chance of absenteeism among workers with chronic diseases is 6.34 times higher when compared to those in the opposite situation. Moreover, there is a higher probability of the occurrence of negative critical incidents with these individuals at work [21]. The presence of chronic diseases associated with a low capacity (physical and mental) for work is correlated with a high risk of long-term absence in the general working population [17]. A study on the association between comorbidities and general labor force participation of Australian workers with back pain showed that an individual with these conditions and heart disease was ten times more likely to be out of the labor force. Absenteeism was also associated with long-term work incapacity among workers with episodes of comorbid depressive disorders or anxiety [22]. Finally, multicomorbidity is common among young adult workers and is related to absenteeism as well as presenteeism at work [23].

In this study, a significant and positive correlation between the CI scores and age and length of service (seniority) was observed, i.e., the level of vulnerability of individual health of legislative workers to diseases and chronic health problems increases with increasing age and length of service. This finding demands attention since in some countries the multimorbidity rates for the population over 65 years of age are estimated at 80–90%, which may represent a greater susceptibility of older workers to the onset of diseases, leading to a greater occurrence of work disability or permanent disability to work.

The results showed no significant differences between men and women regarding the CI scores for the total number of participants, regardless of age or activity. This result may vary when some specific criteria are considered, including education, age, or specific pathology, among others. However, there is usually a prevalence of chronic diseases in the group of women in the general population. Regarding the population aged 18 years or older in Brazil in 2019, hypertension was more prevalent among women (26.4%) when compared to men (21.1%). Likewise, regarding diagnoses of depression, women showed a prevalence of 14.7% when compared to 5.1% among men [16]. More specific population extracts, such as the legislative staff participating in this research, do not necessarily reproduce the general profile of the population in terms of comorbidities.

#### **5. Conclusions**

The main purpose of this study was to evaluate the chronic health condition among civil servants that work in the legislative houses in Brazil, through the comorbidity index, as well as its effects on sickness-related absenteeism, expressed in working days lost.

The statistical analyses revealed that the vast majority of the participants had at least one chronic disease or health problem. In turn, the comorbidity index showed that at least 8 out of 10 of these individuals use medication or other medical treatment, and no less than four individuals reported difficulties or restrictions in performing some activity due to their health condition. Thus, it is reasonable to conclude that the population under study presents a profile strongly characterized by the presence of chronic health conditions, which affect the personal health of these individuals, imposing the need for some kind of medical monitoring and the risk of losing working capacity.

Regarding the effects of the chronic health condition on work absences assessed by the comorbidity index, it was evident that the individual health condition was strongly associated with the working days lost by the civil servants with diseases or chronic problems. Therefore, the presence of diseases or chronic health problems had important effects on the work absenteeism of this group of civil servants. As already discussed, absenteeism is a phenomenon of multifactorial etiology and may be associated with internal and external factors to work. However, individual characteristics such as the socio-demographic profile and individual health conditions act to mitigate or aggravate absences from work activities.

Studies aimed at detailing the prevalence of chronic health problems of workers and the impact of this medical condition on the reduction of working capacity can help in understanding sickness-related absenteeism, providing a more adequate and humanized management of work, with possible positive effects on people's health and productivity.

**Author Contributions:** Writing—review & editing, F.E.S.; Supervision, M.J.S.O., J.A. and E.F. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research has not received any external funding.

**Institutional Review Board Statement:** This study was developed with the approval of the Ethics Committee of the Universidade Federal de Goiás, Brazil, under registration number 3.962.630 on 9 April 2020.

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** The data and information in this article can be found in the doctoral thesis: bsenteísmo-doença de servidores públicos do poder legislativo no Brasil, available from 6 December 2023, in the respository of the University of Porto, Portugal, at the request of the author who decided to publish a book, based on his research. access link: https://repositorio-aberto.up.pt/ handle/10216/147784.

**Conflicts of Interest:** The authors declare no conflict of interest.
