Poor sleep quality was associated with both the presence and degree of presenteeism, whereas insufficient leisure-time physical activity was associated primarily with its presence among Chinese primary care physicians.
Key Findings
Results
Nearly half of Chinese primary care physicians reported presenteeism.
417 of 876 PCPs (47.6%) reported presenteeism.
Presenteeism was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI:GH) version.
876 physicians were included after excluding 338 questionnaires for data quality issues from 1214 returned questionnaires.
Participants were recruited using multistage sampling across all 31 provincial-level administrative regions of mainland China.
Results
Insufficient leisure-time physical activity (LTPA) was associated with higher odds of reporting presenteeism.
Adjusted OR for insufficient LTPA and reporting presenteeism was 1.65 (95% CI 1.20 to 2.28).
This association was with the presence of presenteeism, not the degree of productivity impairment among those who reported it.
LTPA was assessed using a structured questionnaire as part of five lifestyle risk factors examined.
Results
Poor sleep quality was associated with higher odds of reporting presenteeism.
Adjusted OR for poor sleep quality and reporting presenteeism was 1.59 (95% CI 1.12 to 2.26).
Poor sleep quality was associated with both the presence and the degree of presenteeism.
Sleep quality was one of five lifestyle risk factors assessed using a structured questionnaire.
Results
Among PCPs who reported presenteeism, poor sleep quality was associated with a higher presenteeism score.
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).
This analysis was restricted to the 417 PCPs who reported presenteeism.
The presenteeism score reflects degree of productivity impairment as measured by the WPAI:GH.
Results
Smoking was associated with the overall degree of presenteeism, but category-specific estimates differed in direction.
The overall association between smoking and degree of presenteeism was statistically significant (p=0.003).
Category-specific estimates for smoking differed in direction, suggesting a complex or non-linear relationship.
This analysis was conducted among the subset of PCPs who reported presenteeism.
Results
No clear associations were observed between irregular diet or alcohol drinking and presenteeism.
Irregular diet and drinking were examined as two of five lifestyle risk factors.
Neither irregular diet nor drinking showed a clear association with the presence or degree of presenteeism.
These null findings were observed in both the logistic regression (presence) and the marginal effects analysis (degree) models.
Methods
The study used a cross-sectional design with multistage sampling across all 31 provincial-level administrative regions of mainland China.
1500 questionnaires were distributed and 1214 were returned, yielding a response rate of 80.9%.
Following data quality screening, 338 questionnaires were excluded, leaving 876 physicians for analysis.
Eligibility required age ≥18 years, at least 1 year of work in a primary healthcare institution, and written informed consent.
Convenience sampling was used at the area, institution, and physician levels.
What This Means
This research suggests that nearly half of primary care physicians (PCPs) in China experienced presenteeism — the phenomenon of going to work while unwell and being less productive as a result. The study surveyed 876 physicians across all regions of mainland China and found that two lifestyle factors, poor sleep quality and insufficient leisure-time physical activity, were linked to a higher likelihood of reporting presenteeism. Among those who were already experiencing presenteeism, poor sleep quality was also linked to a greater degree of productivity loss. Smoking showed a statistically significant but complex relationship with the degree of presenteeism, while irregular diet and alcohol consumption were not clearly associated with presenteeism in this sample.
This research suggests that sleep and physical activity may be particularly relevant lifestyle factors when it comes to physician productivity and wellbeing. Because these are potentially modifiable behaviors, the findings point to areas where workplace wellness programs or policy interventions might be targeted to help reduce presenteeism among primary care physicians. The authors note that this does not establish cause and effect, as the study design only captures a single point in time.
The broader implication of this research is that physician health and productivity are intertwined, and that lifestyle factors commonly associated with general health may also affect how well doctors can perform their jobs. Given that primary care physicians are often the first point of contact for patients in the healthcare system, reduced productivity among this group could have downstream effects on patient care. Further research using longitudinal designs would be needed to better understand whether improving sleep quality or physical activity levels actually reduces presenteeism among physicians.
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Jia X, Gu Z, Wang J, Xi X. (2026). Association between lifestyle risk factors and presenteeism among Chinese primary care physicians: a cross-sectional study.. BMJ open. https://doi.org/10.1136/bmjopen-2026-120672