Factors Associated with the Odds, Duration, and Costs of Health-Related Absenteeism: A Population-Based Study in São Paulo City, Brazil.

Background/Objectives: Non-Communicable Diseases (NCD) impose a substantial socioeconomic burden on health systems through direct costs and indirect costs from productivity loss due to health-related absenteeism. While lifestyle factors are crucial for NCD prevention, evidence regarding their association with absenteeism in middle-income countries, such as Brazil, remains limited. In this context, the present study aims to analyze factors associated with the odds, duration, and costs of health-related absenteeism in São Paulo City, Brazil. Methods: Quantitative analysis was performed using microdata from the São Paulo Health Survey 2003, 2008, and 2015 (ISA-Capital). Logistic and negative binomial regression models identified factors associated with the odds and duration of health-related absenteeism. The human capital approach was used to estimate indirect costs (Int$ PPP), while two-part regression models (logit and generalized linear model) and average marginal effects (ME) identified cost-associated factors. Results: Tobacco use and NCD diagnoses (hypertension, type 2 diabetes, and cardiovascular diseases) significantly increased the odds and duration of absenteeism. Conversely, meeting recommended leisure-time physical activity levels was associated with lower indirect costs (ME = -33.94, p < 0.05). Higher costs were significantly driven by tobacco use (ME = 48.68, p < 0.01) and NCD, namely cardiovascular diseases (ME = 62.73), diabetes (ME = 55.18), hypertension (ME = 52.13), and obesity (ME = 36.45), all with p < 0.05. Conclusions: Promoting leisure-time physical activity and tobacco cessation may be important strategies for public health policies aiming to enhance productivity by reducing the frequency, duration, and economic burden of health-related absenteeism, complementing the necessary diagnosis and monitoring of NCD.