Introduction: Crohn’s disease (CD) can have negative effects on height development in pediatric patients with CD [1]. An association between reduced adult height and wages in employed persons has previously been reported[2,3]. We calculated the potential reduction in lifetime earnings associated with unrealized adult height resulting from pediatric CD. Methods: Existing estimates of the effect of CD on adult height and the effect of reduced height on wages were combined to develop a stochastic economic model that predicts the reduction in lifetime wages associated with CD in the United States (U.S.). The model used data from a retrospective analysis [4] of adults who developed CD as children to estimate the impact of CD on unrealized height (mean unrealized adult height =2.4 cm; standard deviation [SD] =6.5). We relied on estimates of the association between height and wages [2] (mean % reduction in wage per cm =0.98%, SD=0.22%, including both sexes) to calculate the effect of unrealized height on wages. Earnings were adjusted downward to account for CD. Monte Carlo analysis was used to assess stochastic results. Future earnings were discounted at a rate of 3%. Results: The mean reduction in lifetime earnings (in 2012 U.S.$) associated with CD-attributed lower stature was $32,728 (95% confidence interval [CI]: $57,291 to $13,181). One-way sensitivity analysis varied assumptions for height loss observed in CD patients, indicating a range in lifetime losses of $23,270 to $88,228. When restricting unrealized adult height to the bottom quartile of observations in the data, mean reduction in lifetime earnings was $143,794 (95% CI: $81,920 to $206,954). Variation in assumptions about the size of the height-wage effect indicated losses of $18,466 to $32,131. Higher wage inflation increased reductions in lifetime earnings. If pediatric onset CD affects labor force participation, losses would be higher; for every 1% drop in labor force participation, lifetime earnings are reduced by an additional $39,233. Conclusion: To our knowledge, this is the first assessment of the cost of CD-mediated unrealized height on lifetime earnings in the U.S. Earlier diagnosis, medical, and/or surgical interventions that improve growth outcomes may improve lifetime earnings in patients with CD in the U.S.
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