Work productivity and activity impairment in Spanish Crohnʼs disease patients

Abstract

Crohn's disease (CD) is usually diagnosed in early adult life, a peak time of work productivity, and may interfere with the patient's ability to work and perform daily activities. It often requires hospitalizations and surgery which imply work absences and disability. The relation between CD and the health related quality of life (HRQoL) has been extensively explored, but data about work productivity are scarce. The aim of our study was to determine how CD affects work productivity in a large sample of CD patients in Spain. Spanish multicenter, cross-sectional observational study. CD patients were recruited between 2009 and 2010 through the Spanish CD patient association and by gastroenterologists. Patients provided socio-demographic and clinical information. They completed the “Work Productivity and Activity Impairment Questionnaire” (WPAI) and the “Inflammatory Bowel Disease Questionnaire” (IBDQ9) to assess the HRQoL. The “Overall Work Productivity Loss” (OWPL) and “Daily Activities Impairment” (DAI) were measured. Multivariable analysis was performed to correlate clinical, socio-demographics and HRQoL with work productivity. A total of 1688 patients were recruited: 64% members of a CD association, 51% females, mean age 42.5 years (SD 11.2). At the time of the survey 32% of patients at working age were unemployed or pensioners, and 59% were employed: The mean loss of working time was 3.5 hours (range 0-64, SD 9.59) in the previous week (34% lost >1h/week), and 11% received complaints regarding their work performance. The mean OWPL was 27% (SD 31.3) and the mean DAI index was 35% (SD 31.3). 50% of patients had more than 10% of OWPL and 20% of DAI. There was a significant relationship between IBDQ9 and the components of productivity (p<0.05 in all cases): OWPL, DAI, presenteeism and absenteeism (r=-0.6, -0.7, -0.5 & -0.6 respectively). OWPL and DAI were directly related with the illness activity at the time of the study and surgical interventions in the previous 2 years (p<0.05), and inversely related with the degree of knowledge about their illness (p<0.05). CD affects work productivity and daily activity, which deteriorate the HRQoL. Physicians can improve all these factors by providing comprehensive information and proper control of the illness.