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Permanent Work Disability in Crohn's Disease

Ananthakrishnan, Ashwin N., M.D., M.P.H.1; Weber, Lydia R., B.A.1; Knox, Josh F., P.A.-C.1; Skaros, Susan, P.A.-C.1; Emmons, Jeanne, R.N.1; Lundeen, Sarah, A.P.N.P.2; Issa, Mazen, M.D.1; Otterson, Mary F., M.D., M.S.2; Binion, David G., M.D.1

American Journal of Gastroenterology: January 2008 - Volume 103 - Issue 1 - p 154–161
ORIGINAL CONTRIBUTIONS: INFLAMMATORY BOWEL DISEASE
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OBJECTIVE Crohn's disease (CD) frequently presents during early adulthood, a peak time of work productivity. There are limited data from the United States on work disability from CD. We performed this study to identify clinical factors associated with permanent work disability in a CD tertiary referral cohort.

METHODS Cases were identified as patients who received permanent work disability compensation from the social security administration (SSA) related to CD. Four control patients who were not receiving work disability were selected for each case. Multivariate logistic regression was performed to identify characteristics that were independently associated with work disability.

RESULTS A total of 737 patients with CD were seen in our center, and 185 CD patients were included in our study (37 disability cases, 148 controls). On multivariate analysis, an SIBDQ score ≤50 (OR 12.44, 95% CI 4.45–34.79), undergoing two or more GI surgeries (OR 7.09, 95% CI 2.63–19.11), and two or more medical hospitalizations (OR 2.76, 95% CI 1.03–7.37) were significantly associated with work disability in CD. Disease location (small bowel vs colon), type (inflammatory, stricturing, or fistulizing), or specific treatment strategies were not associated with work disability in our analysis.

CONCLUSION Permanent work disability administered through social security was encountered in 5.3% of the Crohn's patients followed in our cohort. Patients who consistently report low quality of life, or have frequent flares requiring surgical intervention or hospitalization for medical management, may be at risk for CD-related work disability.

1Division of Gastroenterology and Hepatology, and 2Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin

Reprint requests and correspondence: David G Binion, M.D., Division of Gastroenterology and Hepatology, Medical College of Wisconsin, Milwaukee, WI 53226.

Received April 18, 2007; accepted August 1, 2007.

CONFLICT OF INTERESTGuarantor of the article: David G. Binion, M.D.

Specific author contributions: Ananthakrishnan: study conception and design, data collection, statistical analysis, drafting of the manuscript, critical revision and final approval of manuscript. Weber: data collection, critical revision, final approval of manuscript. Knox: data collection, critical revision, final approval of manuscript. Skaros: data collection, critical revision, final approval of manuscript. Emmons: data collection, critical revision, final approval of manuscript. Lundeen: data collection, critical revision, final approval of manuscript. Issa: data collection, critical revision, final approval of manuscript. Otterson: data collection, critical revision, final approval of manuscript. Binion: study conception and design, data collection and interpretation, critical revision and final approval of manuscript.

Financial support: None.

Potential competing interests: None.

© The American College of Gastroenterology 2008. All Rights Reserved.
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