Crohn's disease (CD) is considered one of the most expensive disorders in Europe and the prevalence and incidence of CD is increasing in Brazil in the last decades. During flares, CD can lead to the inability to work with social and economic impact. This study aimed to assess the indirect costs, prevalence and risk factors for work disability in the state of Rio de Janeiro (RJ) and in a tertiary care referral center of the state (UERJ).
Analysis was performed using the database of the Single System of Social Security Benefits Information (SUIBE), with a crosscheck for aid pension and disability retirement from 2010 to 2018 in RJ state. Demographic characteristics included sex, age, work status, geographic region, days off work, average monthly benefit, and ICD-10 K50 with all subdivisions. A sub-analysis was performed on CD patients from UERJ during the same study period using prospectively collected data from the database, analyzed retrospectively to investigate potential risk factors associated with absence from work among CD patients. Additional demographic and clinical characteristics including sex, age, disease duration, disease location, predominant disease phenotype, perianal disease, extraintestinal manifestations, smoking history, prior medications (steroids, immunosuppressants and biologics), duration of biologic use, history of abdominal surgery (defined as the need for bowel resection), prior spontaneous abdominal abscess, previous appendectomy, and Montreal classification were analyzed.
In RJ state, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs (focusing on losses related to employment) of US$ 8,562,195.86. Permanent disability occurred more frequently in CD patients aged 40 to 49 years. In UERJ, the prevalence of work disability was 16.7% and the risk factors for absence from work were predominantly disease duration, the A2 profile of the Montreal classification, abdominal surgery and rectovaginal fistulas. Mood disorders were observed in 19% of these UERJ patients, with a mean interval of 3 years between diagnosis of CD and the first benefit.
The prevalence of work disability in UERJ CD patients is similar to RJ state and may reflect other regions from Brazil. The risk factors are associated with disease duration and complications of disability. The prevalence of psychiatric manifestations has called attention to potentially neglected aspects of CD, and the need to incorporate specialized multidisciplinary care. Rehabilitation programs are still deficient in the country. The increase in the prevalence of CD in Brazil and the resultant socioeconomic impact of a chronic disease affecting relatively young patients, emphasizes the importance of providing quality medical care in order to mitigate the burden of CD. Early diagnosis and full medical therapy might prevent most of the complications that lead to repeat hospitalizations and surgical interventions and the consequent incremental direct and indirect costs associated with CD.