Background: Inflammatory bowel disease can decrease the quality of life and induce work disability. We sought to (1) identify and quantify the predictors of disease-specific work disability in patients with inflammatory bowel disease and (2) assess the suitability of using cross-sectional data to predict future outcomes, using the Swiss Inflammatory Bowel Disease Cohort Study data.
Methods: A total of 1187 patients were enrolled and followed up for an average of 13 months. Predictors included patient and disease characteristics and drug utilization. Potential predictors were identified through an expert panel and published literature. We estimated adjusted effect estimates with 95% confidence intervals using logistic and zero-inflated Poisson regression.
Results: Overall, 699 (58.9%) experienced Crohn’s disease and 488 (41.1%) had ulcerative colitis. Most important predictors for temporary work disability in patients with Crohn’s disease included gender, disease duration, disease activity, C-reactive protein level, smoking, depressive symptoms, fistulas, extraintestinal manifestations, and the use of immunosuppressants/steroids. Temporary work disability in patients with ulcerative colitis was associated with age, disease duration, disease activity, and the use of steroids/antibiotics. In all patients, disease activity emerged as the only predictor of permanent work disability. Comparing data at enrollment versus follow-up yielded substantial differences regarding disability and predictors, with follow-up data showing greater predictor effects.
Conclusions: We identified predictors of work disability in patients with Crohn’s disease and ulcerative colitis. Our findings can help in forecasting these disease courses and guide the choice of appropriate measures to prevent adverse outcomes. Comparing cross-sectional and longitudinal data showed that the conduction of cohort studies is inevitable for the examination of disability.
Article first published online 26 February 2013
*Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, UMIT–University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
†Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
‡Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts
§Division of Public Health Decision Modeling, Health Technology Assessment and Health Economics, ONCOTYROL – Center for Personalized Cancer Medicine, Innsbruck, Austria
‖Division of Gastroenterology, Kantonsspital St. Gallen, St Gallen, Switzerland
¶Division of Gastroenterology, Stadtspital Triemli, Zürich, Switzerland
**Division of Psychosomatic Medicine, Department of General Internal Medicine, Bern University Hospital, Inselspital and University of Bern, Bern, Switzerland.
Reprints: Uwe Siebert, MD, MPH, MSc, ScD, Institute of Public Health, Medical Decision Making and Health Technology Assessment, Dept. of Public Health and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, A-6060 Hall in Tirol, Austria (e-mail: firstname.lastname@example.org).
Supported by a research grant from the Swiss National Science Foundation grant 3347CO-108792 (Swiss IBD Cohort) and 320000-114009/1 (to S.R.V.) and an unrestricted educational grant by Abbott, Switzerland.
Members of the Swiss Inflammatory Bowel Disease Cohort Study are listed in Appendix 1.
Received June 04, 2012
Accepted June 20, 2012