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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Prevalence of- and risk factors for work disability in Dutch patients with inflammatory bowel disease
Lieke M Spekhorst, Bas Oldenburg, Ad A van Bodegraven, Dirk J de Jong, Floris Imhann, Andrea E van der Meulen-de Jong, Marieke J Pierik, Janneke C van der Woude, Gerard Dijkstra, Geert D’Haens, Mark Löwenberg, Rinse K Weersma, Eleonora A M Festen, Parelsnoer Institute and the Dutch Initiative on Crohn and Colitis
Lieke M Spekhorst, Floris Imhann, Gerard Dijkstra, Rinse K Weersma, Eleonora A M Festen, Department of Gastroenterology and Hepatology, University of Groningen and University Medical Centre Groningen, Groningen, 9700 RB Groningen, the Netherlands
Lieke M Spekhorst, Floris Imhann, Eleonora A M Festen, Department of Genetics, University of Groningen and University Medical Centre Groningen, Groningen, 9700 RB Groningen, the Netherlands
Bas Oldenburg, Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, 3584 CX Utrecht, the Netherlands
Ad A van Bodegraven, Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, 1081 HV Amsterdam, the Netherlands
Dirk J de Jong, Department of Gastroenterology and Hepatology, University Medical Center St. Radboud, Nijmegen, 6525 GA Nijmegen, the Netherlands
Andrea E van der Meulen-de Jong, Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, 2333 ZA Leiden, the Netherlands
Marieke J Pierik, Department of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, 6229 HX Maastricht, the Netherlands
Janneke C van der Woude, Department of Gastroenterology and Hepatology, Erasmus Medical Center, the Netherlands, Rotterdam, 3015 CE Rotterdam, the Netherlands
Geert D’Haens, Mark Löwenberg, Department of Gastroenterology and Hepatology, Amsterdam Medical Center, Amsterdam, 1105 AZ Amsterdam-Zuidoost, the Netherlands
Author contributions: The Parelsnoer Institute, founded by the Dutch Federation of University Medical Centers, provided the research infrastructure; Oldenburg B, van Bodegraven AA, de Jong DJ, van der Meulen-de Jong AE, Pierik MJ, van der Woude JC, Dijkstra G, Imhann F, Festen EAM and Weersma RK enrolled the IBD patients, collected the patient data and performed a critical revision of the manuscript; Weersma RK, Spekhorst LM and Festen EAM designed the study, Spekhorst LM interpreted the data, performed the statistical analysis and drafted the manuscript; all authors approved the final manuscript.
Supported by the Netherlands Organisation for Scientific Research, VIDI grant No. 016.136.308 to Weersma RK; Career Development grant of the Dutch Digestive Foundation, No. CDG 14-04 to Festen EAM.
Institutional review board statement: This nationwide Parelsnoer Institute project is part of and funded by the Netherlands Federation of University Medical Centers and has received initial funding from the Dutch Government (from 2007-2011). The Parelsnoer Institute currently facilitates the uniform nationwide collection of information on and biomaterials of thirteen other diseases.
Informed consent statement: All patients included in this study gave informed consent prior to study inclusion.
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: Festen EAM is accepting full responsibility for the conduct of the study. This author has had access to the data and had control of the decision to publish.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Eleonora AM Festen, MD, PhD, Department of Gastroenterology and Hepatology, University of Groningen and University Medical Centre Groningen, Hanzeplein 1, Groningen, 9700 RB Groningen, the Netherlands.
e.a.m.festen@umcg.nl
Telephone: +31-503-610426 Fax: +31-503-619306
Received: June 28, 2017
Peer-review started: June 28, 2017
First decision: July 27, 2017
Revised: August 26, 2017
Accepted: September 13, 2017
Article in press: September 13, 2017
Published online: December 14, 2017
Processing time: 167 Days and 13.7 Hours
AIM
To determine the prevalence of work disability in inflammatory bowel disease (IBD), and to assess risk factors associated with work disability.
METHODS
For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability (sick leave, partial and full disability) and long-term full work disability (> 80% work disability for > 2 years).
RESULTS
Prevalence of work disability was higher in Crohn’s disease (CD) (29%) and ulcerative colitis (UC) (19%) patients compared to the general Dutch population (7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years, smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level (OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications (OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability.
CONCLUSION
The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.
Core tip: Our study shows that a lower education is patients with Crohn’s disease, and disease complications (osteopenia, thromboembolic event) in patients with ulcerative colitis are associated with long-term full work disability (> 80% work disability for > 2 years). This highlights the need for early assessment of risk factors for work disability, as work disability is substantial among inflammatory bowel disease patients and associated with high societal health care costs.
