Patients with severe childhood-onset IBD earned ‘markedly’ less in early adulthood
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Individuals with severe childhood-onset inflammatory bowel disease, who underwent surgery or long-term inpatient care, had 16% lower occupational earnings from age 20 to 30 years compared with the general population, according to research.
“We have recently demonstrated that patients with adult-onset IBD have significantly lower taxable earnings up to 10years after diagnosis than IBD-free siblings,” Petter Malmborg, MD, PhD, of Sachs’ Children and Youth Hospital and the department of clinical science and education at the Karolinska Institute in Stockholm, and colleagues wrote in Alimentary Pharmacology & Therapeutics. “Several studies have also shown that adult-onset IBD has a negative impact on work ability and professional career as patients are reported to have more sick leave, disability pension and unemployment than the general population.
“It seems plausible that childhood-onset IBD can have profound negative consequences for later educational and professional career, but very few studies have addressed this association.”
In a nationwide, population-based cohort study, Malmborg and colleagues compared 5,404 individuals with childhood-onset IBD (diagnosed < 18 years) in the Swedish National Patient Register with 51,295 IBD-free matched individuals from the general population. Among patients with IBD, 52% had ulcerative colitis, 43% had Crohn’s disease and 5% had unidentified IBD. The majority of patients were boys (56%) and 47% received their IBD diagnosis before 15 years of age.
Researchers also collected data on inflation-adjusted earnings from 1992 to 2017 and calculated the difference through quantile regression. The primary studied outcome was annual taxable earnings among patients aged 20 to 30 years.
Socioeconomic status evaluation showed that 1,809 patients with childhood-onset IBD who reached age 30 during the study period had similar education (> 12 years education: 47.4% vs. 47.1%), marital status (married: 20.8% vs. 22.5%) and unemployment status (unemployed: 6.8% vs. 7.2%) compared with the general population. However, a larger proportion of patients with childhood-onset IBD had disability pension (5% vs. 2.8%) and were on sick leave (16.6% vs. 10.3%).
Of 403 patients who underwent IBD-related surgery or long-term inpatient treatment during childhood, fewer attained more than 12 years of education (41.9% vs. 47.2%) but had similar marital (married: 20.3% vs. 23.7%) and unemployment status (unemployed: 7.7% vs. 8.1%) compared with the general population. Severe disease during childhood also correlated with increased disability pension (8.7% vs. 2.5%) and sick leave (22.1% vs. 10.5%) at age 30.
Earnings analysis showed patients with childhood-onset IBD had lower median annual taxable earnings at age 30 compared with the general population (24,200 vs. 26,400 ). After adjustment, Malmborg and colleagues estimated a –1,300 difference (95% CI, –2,200 to –400) between individuals with and without IBD, which equated to –5.4% (95% CI, –9.1 to –1.8) lower annual taxable earnings. This trend was greater among patients who underwent IBD-related surgery or long-term inpatient treatment during childhood (–16.3%; 95% CI, –24.7 to –7.9).
“We found that childhood-onset IBD patients overall had significantly lower earnings in early adult age compared to matched general population reference individuals,” Malmborg and colleagues wrote. “Our study also demonstrated that patients with more severe disease during childhood (exposed to IBD-related surgery or long-term inpatient treatment) had markedly lower earnings throughout early adult age (–16% at age 30).”
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