S0691 Worsening Patient-Reported Outcomes With Increasing Disease Severity in Ulcerative Colitis in the USA: The National Health and Wellness Survey

Abstract

INTRODUCTION: Ulcerative colitis (UC) is a debilitating disease that leads to poor patient well-being. We aimed to establish the relationship between self-reported UC severity and patient-reported outcomes (PROs). METHODS: Data from the 2019 US National Health and Wellness Survey (NHWS)—a self-administered, internet-based survey that is representative of the US adult population in terms of age, sex, and race/ethnicity (N = 74,895)—were used. Patients with UC were defined by self-reported UC diagnosis. Respondents were categorized by self-reported UC severity: mild (n = 464), moderate/severe (n = 233), and non-UC controls (NUC) (n = 74,198). Patient-reported outcomes (PROs) were measured by SF-36v2, SF-6D, EQ-5D Visual Analogue Scale (VAS), and Work Productivity and Activity Impairment (WPAI). Bivariate analyses were conducted to evaluate differences between UC groups (mild vs moderate/severe vs NUC). Categorical variables were analyzed using chi-square tests; continuous variables by analysis of variance. Two-tailed P values < 0.05 were considered statistically significant. RESULTS: Mean age (Table 1) differed significantly between groups (NUC = 47.6 ± 17.3, mild = 51.4 ± 16.9; moderate/severe = 43.8 ± 14.8; P < 0.001), whereas sex did not (NUC = 43.1% male, mild = 40.5%; moderate/severe = 45.5%; P = 0.0405). Mean SF36v2 scores (Table 2) significantly decreased with disease presence and severity for both mental (NUC = 46.6 ± 11.8, mild = 44.7 ± 12.4, moderate/severe = 38.2 ± 11.4; P < 0.001) and physical (NUC = 50.3 ± 9.5, mild = 45.8 ± 10.1, moderate/severe = 40.7 ± 10.4; P < 0.001) components. Similar trends were observed for mean SF-6D (NUC = 0.72 ± 0.14, mild = 0.67 ± 0.15, moderate/severe = 0.57 ± 0.14; P < 0.001), and EQ-5D VAS (NUC = 75.5 ± 22.5, mild = 68.5 ± 24.98, moderate/severe = 61.1 ± 28.1; P < 0.001). WPAI outcomes were poorer with increasing disease severity, including absenteeism (NUC = 8.5 ± 19.6%, mild = 16.6 ± 25.2%, moderate/severe = 28.2 ± 26.6%; P < 0.001), presenteeism (NUC = 21.5 ± 29.3%, mild = 34.7 ± 34.9%, moderate/severe = 58.9 ± 31.8%; P < 0.001), and overall work impairment (NUC = 24.2 ± 31.7%, mild = 38.4 ± 37.3%, moderate/severe = 65.3 ± 33.6%; P < 0.001). UC symptoms (Table 3) were more prevalent and frequent in the moderate/severe group (P < 0.05). CONCLUSION: PROs worsened with UC disease severity. Patients with moderate/severe UC demonstrated significantly worse absenteeism, presenteeism, and lower scores on the SF-36v2, EQ-5D, and SF-6D than those with mild UC or without UC. Appropriate management of UC may reduce disease severity and potentially improve outcomes and PROs.Table 1Table 2Table 3