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Patients with Crohn’s start missing work before diagnosis
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Patients with Crohn’s disease miss more time at work than other individuals, and the trend can start before they are diagnosed, according to research published in Inflammatory Bowel Diseases.
Åsa H. Everhov, MD, PhD, of the department of surgery at Stockholm South General Hospital in Sweden, and colleagues wrote that previous studies have explored work absences in CD but only in patients with established disease.
“The effect of Crohn’s disease on work ability needs to be evaluated both in relation to a comparison group without inflammatory bowel disease and in relation to work ability before diagnosis,” they wrote. “Extraintestinal manifestations and comorbidity, especially various types of psychiatric diseases, have a major impact on the ability to work and can appear before first diagnosis of Crohn’s disease.”
Researchers used nationwide registries to identify patients diagnosed with CD between 2007 and 2010 (n = 2,015) and matched them to non-IBD patients based on factors including age, sex and education level (n = 10,067). They tracked lost workdays due to sick leave and disability from 5 years before diagnosis to 5 years after or the end of follow-up.
Investigators found that in the 5 years before diagnosis, the CD group had a higher proportion of patients with work loss (25%) and mean annual number of lost work days (45 days) compared with the non-IBD group (17%; 29 days).
Although patients with CD experienced increased work loss during the year of diagnosis, it declined to pre-diagnosis levels afterward.
The differences between groups came from a relatively small number of patients. Of the entire study cohort, 75% did not miss any work 24 to 12 months prior to diagnosis, and 84% of those individuals had “full work ability” 12 to 24 months after diagnosis. Of the 8.3% of individuals with total work loss before diagnosis, 83% did not work after.
Among patients who had full work ability before diagnosis, the risk for having total work loss afterward was 1.4%, and the risk in the comparison group was 0.43%.
While disease factors like duration, intestinal resection and perianal surgery have been associated with increased sick leave for patients diagnosed with CD, Everhov and colleagues wrote that they cannot explain why patients still miss work before they are diagnosed.
“One possible explanation is presence of symptoms long before diagnosis, that is, doctor and patient delay,” they wrote. “Many health care systems have problems with queues. Waiting for a specialist appointment, an endoscopy, a histopathology report, or elective surgery can all constitute part of diagnostic delay.” – by Alex Young
Disclosures: Everhov reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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