ArticleBMJ open2026
Association between lifestyle risk factors and presenteeism among Chinese primary care physicians: a cross-sectional study.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesThis study aimed to examine whether lifestyle risk factors were associated with reporting any presenteeism and among primary care physicians (PCPs) who reported presenteeism, with the degree of productivity impairment.
designCross-sectional study.
settingPrimary healthcare institutions across all 31 provincial-level administrative regions of mainland China.
participantsPCPs were eligible if they were aged ≥18 years, had worked in a primary healthcare institution for at least 1 year and provided written informed consent. Participants were recruited using multistage sampling with convenience sampling at the area, institution and physician levels. Of the 1500 questionnaires distributed, 1214 were returned, yielding a response rate of 80.9%. Following data quality screening, 338 questionnaires were excluded, leaving 876 physicians for analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Presenteeism was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health version. Lifestyle risk factors (irregular diet, insufficient leisure-time physical activity (LTPA), poor sleep quality, smoking and drinking) were assessed using a structured questionnaire.
resultsAmong the 876 PCPs included in the analysis, 417 (47.6%) reported presenteeism. Insufficient LTPA and poor sleep quality were associated with higher odds of reporting presenteeism (adjusted OR (aOR) 1.65, 95% CI 1.20 to 2.28; and aOR 1.59, 95% CI 1.12 to 2.26, respectively). Among PCPs reporting presenteeism, poor sleep quality was associated with a 3.85-percentage-point higher presenteeism score (average marginal effect 3.85, 95% CI 0.32 to 7.38). Smoking was associated overall with the degree of presenteeism (p=0.003), with category-specific estimates differing in direction. No clear associations were observed for irregular diet or drinking.
conclusionsPoor sleep quality was associated with both the presence and degree of presenteeism, whereas insufficient LTPA was associated primarily with its presence. Sleep quality and LTPA may warrant further investigation as potentially modifiable factors associated with presenteeism among PCPs.
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