To what extent do job insecurity, income satisfaction, and self-rated health mediate the association between low income and presenteeism in Germany? A gendered analysis.

PURPOSE: Low income is considered a possible determinant of presenteeism, explained by poor working and living conditions, increased levels of uncertainties and anxiety, and poor health status. We aimed to examine the association between low income and presenteeism by gender and to explain their association using different mediators. METHODS: A total of 14,299 employees aged 18-65 from the 6th BIBB/BAuA Employment Survey 2012 were used, and mediation analyses with inverse odds weighting stratified by gender were conducted. RESULTS: Low income was significantly associated with presenteeism for men at a significant level of α < .05 (ß: 0.376; 95%-CI 0.148-0.604) and for women at a significant level of α < .10 (ß: 0.120; 95%-CI - 0.015-0.255). The total effect (TE) was fully and significantly mediated for women when all mediator-weights were considered, whereas for men the consideration of single mediator-weights led to a full and significant mediation of the association between low income and presenteeism. Self-rated health status and income satisfaction contributed the most to the differences in presenteeism by low income with a proportion mediated of 96.3% (men) and 169.2% (women) for self-rated health and 101.6% (men) and 162.5% (women) for income satisfaction. DISCUSSION: The results indicated a strong association between low income and presenteeism, in particular for men. Self-rated health and income satisfaction were the most important mediators of this association. The results underline not only the relevance of occupational health management and preventive measures, but also the need of a public debate about employment traditions, possibly resulting in role conflicts among men, and wage equality to prevent presenteeism of low-income earners.