Objective: To examine whether downsizing, the reduction of personnel in organisations, is a predictor of increased sickness absence and mortality among employees.

Design: Prospective cohort study over 7.5 years of employees grouped into categories on the basis of reductions of personnel in their occupation and workplace: no downsizing (< 8% reduction), minor downsizing (8-18%), and major downsizing (> 18%).

Setting: Four towns in Finland.

Participants: 5909 male and 16 521 female municipal employees, aged 19-62 years, who kept their jobs.

Main outcome measures: Annual sickness absence rate based on employers' records before and after downsizing by employment contract; all cause and cause specific mortality obtained from the national mortality register.

Results: Major downsizing was associated with an increase in sickness absence (P for trend < 0.001) in permanent employees but not in temporary employees. The extent of downsizing was also associated with cardiovascular deaths (P for trend < 0.01) but not with deaths from other causes. Cardiovascular mortality was 2.0 (95% confidence interval 1.0 to 3.9) times higher after major downsizing than after no downsizing. Splitting the follow up period into two halves showed a 5.1 (1.4 to 19.3) times increase in cardiovascular mortality for major downsizing during the first four years after downsizing. The corresponding hazard ratio was 1.4 (0.6 to 3.1) during the second half of follow up.

Conclusion: Organisational downsizing may increase sickness absence and the risk of death from cardiovascular disease in employees who keep their jobs