Telework Linked to Increased Presenteeism

Employees who work from home more frequently are more likely to keep working even when they are sick, reports a study in the December Journal of Occupational and Environmental Medicine.

Dr. Corinna Steidelmüller and colleagues of the Federal Institute for Occupational Safety and Health, Dortmund, Germany, analyzed data from a 2015 survey of working conditions in the European Union. The results showed that home-based telework is “strongly and significantly associated with presenteeism” — working despite illness.

For example, employees who worked from home at least several times per week had an 11-percentage point increase in the likelihood of working while sick at least once over the last year, compared to those who never worked from home. Employees who worked from home every day reported working nearly 15 percent of days they were sick, compared to three percent of days for those who did telework less often.

Estimates of sickness presenteeism were slightly higher for men than women, independent of telework. The results were similar across countries and in different groups of employees, including jobs where telework is more common.

Even before the COVID-19 pandemic, flexible work designs such as telework were becoming more common. Telework has advantages including reduced commuting time, increased autonomy, and better work-life balance. But increased responsibilities and demands also raise the risk for “self-endangering” behaviors, such as working more intensely and working longer hours, including during leisure time.

That’s consistent with a phenomenon known as the “autonomy paradox,” where higher work autonomy and flexibility actually lead to increased organizational control over employees’ lives. The authors note that being able to work despite illness may be beneficial for some employees, such as those with certain chronic diseases.

The study adds to previous research pointing to “the potential harm of flexible work by increasing self-endangering behavior,” Dr. Steidelmüller and coauthors write. They conclude: “Organizations and leaders should therefore be aware of potential health risks associated with telework and should design telework in a way that it aims to reduce the triggers for self-endangering behavior such as presenteeism as far as possible.”
About the Author
Dr. Steidelmüller may be contacted for interviews at
ACOEM (, an international society of 4,000 occupational physicians and other health care professionals, provides leadership to promote optimal health and safety of workers, workplaces, and environments.
About the Journal of Occupational and Environmental Medicine
The Journal of Occupational and Environmental Medicine ( is the official journal of the American College of Occupational and Environmental Medicine. Edited to serve as a guide for physicians, nurses, and researchers, the clinically oriented research articles are an excellent source for new ideas, concepts, techniques, and procedures that can be readily applied in the industrial or commercial employment setting.


Steidelmüller C, Meyer S-C, Müller G. Home-based telework and presenteeism across Europe. J Occup Environ Med. 2020;62(12):998-1005.