Research Article: Paid sick days and stay-at-home behavior for influenza

Date Published: February 2, 2017

Publisher: Public Library of Science

Author(s): Kaitlin Piper, Ada Youk, A. Everette James, Supriya Kumar, Donald R. Olson.


Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees’ decisions to stay home from work for their own or a child’s illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee’s own or a child’s illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee’s own illness/injury, ILI, or influenza, and for a child’s illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee’s own or a child’s illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child’s illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and families.

Partial Text

People’s willingness to stay home from work and keep children away from school when ill is an important component of containing a contagious disease outbreak. For example, beginning with the 2009 H1N1 flu epidemic, the CDC recommended that people with influenza-like illness (ILI) stay home for an additional 24 hours after the fever subsides [1–3]. However, not everyone is able to adhere to these recommendations. One reason people may not engage in stay-at-home behavior is lack of access to paid sick days (PSD) [4–7].

The MEPS is an on-going, nationally representative survey that collects data on demographic factors, medical conditions, and health care usage from households across the US. The survey gathers data on each individual in participating households. The sample is drawn from a representative subsample of households that participated in the previous year’s National Health Interview Survey. MEPS features several rounds of interviews taking place over the course of 2 years [26]. For this study, we used data from 12,901 households collected during the 3 rounds of interviews in 2009.

Our sample consisted of 12,044 employees over 16y age. The average age was 40.40 years (SD = 13.65). As shown in Table 1, 64% had access to PSD. Access to PSD was significantly associated with gender, race/ethnicity, income quartile, and education. Significantly higher proportions of employees in workplaces with > = 50 employees, and of those who reported good/very good/excellent health had access to PSD (Table 1). Table 2 presents the demographic characteristics of the 4,911 employees with children. In this sub-sample, 68% had PSD, and access varied by similar demographic and workplace characteristics as for the overall sample. A higher proportion of parents with no unemployed adults at home had access to PSD (Table 2).

Staying home from work when ill, especially with infectious illnesses such as influenza, is an important health behavior and recommendation from the CDC [1–3]. By examining demographic and workplace characteristics associated with this behavior, our study identifies sub-groups of employees that face barriers to engaging in this recommended behavior, and highlights the continued role of employed women in providing care when a child is ill.

In sum, we have shown that PSD access is associated with the CDC-recommended behavior of staying home from work when sick for an employee’s own illness/injury, ILI, or influenza. In addition, ethnic disparities exist in employees’ ability to engage in this behavior with Hispanics having a lower prevalence of staying home when ill, and possibly facing additional barriers to this health behavior in small workplaces. Females remain the primary caregivers for sick children. Though PSD access is not associated with parental stay-at-home behavior when children have ILI or influenza, access to this resource may lower the economic burden faced by families when a parent (often the mother) has to take time off from work to care for a sick child. Future studies should examine the costs and benefits of PSD laws to small and large workplaces and to society.