A cross-sectional observational study of clinical and demographical factors affecting work disability and health related quality of life in Crohnʼs disease patients

Abstract

Background: Crohn's disease (CD) is a chronic inflammatory bowel disease with a relapsing/remitting course that primarily affects young adults. It's associated with severe complications such as bowel stricture, perforation, abscess and fistula formation. CD often requires hospitalization and surgery leading to absenteeism and disability. The aim of our study was to evaluate clinical and demographical factors affecting these patients, and their impact in work productivity and health related quality of life (HRQoL). Methods: Spanish multicentre, cross-sectional observational study. Patients with CD were included between 2009 2010. The vast majority were recruited by the Spanish CD patient association and others by gastroenterologists. Patients answered a survey providing clinical and demographical data, HRQoL, work productivity and daily activity. Results: A total of 1688 patients were included. Fifty one per cent of patients were females and 49% were males. Median age was 39 years. One third (30%) were smokers. Most patients (86.88%) were diagnosed of CD more than two years before. In the previous two years, 19.1% of patients underwent surgery, 34.4% had been hospitalized (mean 22.5 days) and in 72% a colonoscopy was performed. At the time of the survey, 38.5% of patients reported activity of the disease. Patients referred a mean loss of 3 hours and 30 minutes at their work due to CD on the last 7 days, but when they referred disease activity that mean lost was 5 h and 36 min. The most commonly drugs used were azathioprine (41.4%), mesalamine (35%) and biological therapy (21.3%). The adherence to treatment was good for 88.7%; only 15.6% recognised difficulties in treatment. Patients receiving anti-TNF treatment reported better work productivity (p = 0.016) and daily activity (p = 0.001). HRQoL was significantly related to work productivity (p < 0.05). Conclusions: Our study shows a high prevalence of activity symptoms in the CD patients recruited, as well as a high frequency of previous surgery, hospitalizations and colonoscopy in a short period of time. Biological treatment is associated with better work productivity and daily activity. HRQoL is also associated with better work productivity.