Work Disability in Inflammatory Bowel Disease: First Results From the COIN study

Abstract

Introduction: Chronic work disability is an important medical and social consequence of inflammatory bowel disease (IBD) and is associated with a substantial economic burden to society. To date, only few data exist on factors predicting work disability. Aim: The study on ‘Costs Of IBD in the Netherlands’ (COIN) aims to assess work disability, quality of life and direct and indirect costs in a large cohort of IBD patients in the Netherlands and to determine demographic, disease and work specific factors associated with these endpoints. Here, we report the baseline characteristics of the first 942 patients enrolled in this trial. Methods: Between October 1st 2010 and December 1st 2010, a total of 15,000 patients with IBD were invited by post to participate in the COIN study, which consists of a baseline and follow up web-based questionnaire every 3 months for a total of 2 years. The baseline data includes questions on demographic, disease and work specific characteristics, and a health-related quality of life questionnaire (HRQoL). All data from questionnaires ‘returned’ until November 25th 2010 were analyzed. Descriptive statistics were used to characterize patients with Crohn's disease (CD) and Ulcerative colitis (UC). Multivariate logistic regression analyses were performed to assess the association between chronic work disability and disease characteristics. Results: A total of 942 patients were included, of which 537 (57%) CD patients (35% males, mean age 46 ±14 years) and 405 (43%) UC patients (52% males, mean age 50±13 years). Patients were included from university medical centers (n=487; 52%) and general hospitals (n=455; 48%). Twenty six percent (n=139) of CD patients were chronically disabled, compared to 17% (n=68) of UC patients (Odds ratio (OR) 0.58, 95%CI 0.42-0.80). Disabled CD and UC patients had a lower EQ-5D as compared to employed patients (0.67 ±0.24 vs. 0.87 ±0.14, p 40 years (adjusted (adj.) OR 2.02; 95%CI 1.213.36), smoking (adj. OR 1.69, 95% 1.02-2.81), disease duration (adj. OR 1.02, 95%CI 1.001-1.05) and endostomy (adj. OR 2.73, 95%CI 1.49-5.00) were independently associated with work disability. In UC patients, only age > 40 was associated with disability (adj. OR 2.20, 95%CI 1.01-4.79). Conclusion: In conclusion, almost a quarter of all IBD patients have disabling disease. This is more pronounced in CD than UC. Patients at risk for work disability are those at older age (>40 years) and with a low quality of life in both CD and UC, whereas in CD patients, also smoking, a longer disease duration and an endostomy are involved.