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Youssef M, Hossein-Javaheri N, Hoxha T, Mallouk C, Tandon P. Work Productivity Impairment in Persons with Inflammatory Bowel Diseases: A Systematic Review and Meta-analysis. J Crohns Colitis 2024; 18:1486-1504. [PMID: 38647194 PMCID: PMC11369077 DOI: 10.1093/ecco-jcc/jjae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/23/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND AND AIMS The impact of inflammatory bowel disease [IBD] on work productivity remains unclear. In this systematic review and meta-analysis, we quantify work-related outcomes and employment data among persons with IBD. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, the Cochrane library, Scopus, ProQuest, and clinicaltrials.gov from inception to February 2023, to identify studies on work productivity in persons with IBD aged > 18 years. Work productivity was defined primarily by the Work Productivity and Activity Impairment [WPAI] questionnaire which includes absenteeism, presenteeism, overall work impairment, and non-work activity impairment. In addition, we included data on employment, sick leaves, disability pensions, and indirect costs due to productivity loss. Pooled effect analysis was conducted using a random-effects model for pooled estimates of continuous and proportional data with 95% confidence intervals. RESULTS Among all patients with IBD, the pooled estimates were 16.4% for absenteeism, 35.9% for presenteeism, 39.4% for overall work impairment, and 46.0% for non-work activity impairment. Indirect costs from overall work impairment were 5131.09 euros/patient/year. Only two-thirds of IBD patients were employed, and one in three lost their jobs due to IBD. Among those employed, 39.5% report sick days, 21.3% report work disability, and 12.3% receive disability pensions. Most studies demonstrate clinically meaningful improvements in work productivity with medical and/or surgical therapies. CONCLUSION Persons with IBD experience significant work impairment and associated indirect costs. This highlights the need for appropriate workplace accommodations and timely medical therapy to alleviate the burden of disease and improve work outcomes.
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Affiliation(s)
- Michael Youssef
- Department of Internal Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Tedi Hoxha
- Department of Internal Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Parul Tandon
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, ON, Canada
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Pan T, Chen D, Yu Z, Liu Q, Chen Y, Zhang A, Kong F. Analysis of current situation and influencing factors of marital adjustment in patients with Crohn's disease and their spouses. Medicine (Baltimore) 2024; 103:e37527. [PMID: 38489689 PMCID: PMC10939668 DOI: 10.1097/md.0000000000037527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
The purpose of this study was to investigate the marital adjustment of patients with Crohn's disease and their spouses, and to analyze its influencing factors. It lays the investigation foundation for the follow-up binary study of Crohn's disease patients and their spouses. Using convenience sampling, 177 pairs of patients and their spouses from a tertiary hospital in Nanjing, China were selected. With face-to-face electronic questionnaires to survey the patient and spouse, the contents include the Lock-Wollance Marriage Adjustment Test, Subjective Well-Being Scale for Chinese Citizens, Couple Support Questionnaire, and Distress Self-Disclosure Scale. The marital adjustment score of patients was (99.03 ± 24.25), and the marital adjustment score of spouses was (99.61 ± 25.39). The proportions of patients with marital disorders and their spouses with marital disorders were 52.5% and 46.9%, respectively. Multiple linear regression showed that the spouse's age, family monthly income, time of diagnosis of Crohn's, distress self-disclosure, marital support, and subjective well-being were important factors influencing the marital adjustment of patients. Self-disclosure of spousal distress, marital support, age, and subjective well-being were important factors that influenced spouses' marital adjustment. Most couples with Crohn's disease have marital disorders, and their marital adjustment affects each other. However, the assessment results of one partner should not be limited to replacing those of the couple. In clinical practice, patient age, monthly family income, self-disclosure of distress, marital support, and subjective well-being should be considered. Spouses should be encouraged to participate in patient care and patient-spouse interventions should be implemented as a whole to improve marital stability.
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Affiliation(s)
- Ting Pan
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Danlei Chen
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhihui Yu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Qing Liu
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Yan Chen
- Department of Nursing, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Nanjing Second Hospital), Nanjing, China
| | - Ailing Zhang
- Nanjing Hospital Affiliated to Nanjing Medical University (Nanjing First Hospital), Nanjing, China
| | - Fang Kong
- Digestive Disease Treatment Center, Nanjing Hospital Affiliated to Nanjing University of Chinese Medicine (Nanjing Second Hospital), Nanjing, China
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Sachar Y, Gill JS, Chande N. Impact of inflammatory bowel disease on student experience in postsecondary education. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2024; 72:203-209. [PMID: 35113774 DOI: 10.1080/07448481.2021.2025382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 08/16/2021] [Accepted: 12/26/2021] [Indexed: 06/14/2023]
Abstract
Objectives: This literature review seeks to identify based on the current literature how the burden of disease for IBD patients manifests itself as this cohort transitions simultaneously from pediatric to adult care and from secondary to post-secondary education. Methods: This paper reviews the current literature regarding postsecondary students with IBD and provides a summary of research regarding key factors in their quality of experience. The research was conducted through databases including Taylor & Francis, PubMed, as well as searches via Google Scholar. Results: Over the course of this search, thirty-three relevant studies were identified. These studies addressed the themes outlined in this paper, including academic performance, social adaptation, transition of care, as well as overall transition to a postsecondary institution. Each of these is further broken down to identify specific determinants of IBD student experience. Conclusions: Although students with IBD can demonstrate resilience and adaptive behavior, the evidence suggests there are significant limitations impacting their perceived experience. The barriers IBD students face impact their ability to experience postsecondary education as they intend to, forcing them to adjust in adaptive or maladaptive manners. This review also attempts to generate possible solutions to specific barriers identified from current research, generating directions of action for students, physicians, and academic supports.
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Affiliation(s)
- Yashasavi Sachar
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jaskaran Singh Gill
- Department of Medicine, Temerty School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nilesh Chande
- Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Division of Gastroenterology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Norouzkhani N, Bahari A, Faramarzi M, Shokri Shirvani J, Eslami S, Tabesh H. Development and Validation of an Educational Book on Self-Management in Inflammatory Bowel Disease Based on Patient Preferences and Expert Opinions: A Methodological Study. J Clin Med 2023; 12:7659. [PMID: 38137727 PMCID: PMC10744084 DOI: 10.3390/jcm12247659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Self-management education resources for inflammatory bowel disease (IBD) using concepts remain infrequent. We aim to describe the development and evaluation process of educational material for self-management in IBD based on patient preferences and expert opinions. RESEARCH DESIGN AND METHODS The method of this study includes two main phases of development and validation in five steps in the following order: (1) identification of information needs for patients with IBD; (2) content development with a comprehensive literature review and scientific texts related to IBD; (3) measuring the face validity of the content based on the expert opinions in the field of IBD; (4) validation of the content with the experts in the field of IBD; and (5) validation by target audiences. RESULTS The expert panel comprises ten gastroenterologists, nutritionists, psychologists, gynecologists, and nurses. The total suitability score is 79.5%. The final draft version of the educational self-management material was presented to 30 IBD patients who were satisfied (n = 24; 80%) with the material. CONCLUSIONS This study shows the development process and is validated for face and content validity by the academic multidisciplinary expert panel and target group. Patients and their caregivers can use this content to cope with their disease.
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Affiliation(s)
- Narges Norouzkhani
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran or (N.N.)
| | - Ali Bahari
- Department of Internal Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Mahbobeh Faramarzi
- Population, Family and Spiritual Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47754, Iran;
| | - Javad Shokri Shirvani
- Department of Internal Medicine, Babol University of Medical Sciences, Babol 47176-47754, Iran
| | - Saeid Eslami
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran or (N.N.)
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 13944-91388, Iran or (N.N.)
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Chen X, Xiang X, Xia W, Li X, Wang S, Ye S, Tian L, Zhao L, Ai F, Shen Z, Nie K, Deng M, Wang X. Evolving Trends and Burden of Inflammatory Bowel Disease in Asia, 1990-2019: A Comprehensive Analysis Based on the Global Burden of Disease Study. J Epidemiol Glob Health 2023; 13:725-739. [PMID: 37653213 PMCID: PMC10686927 DOI: 10.1007/s44197-023-00145-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Asia's inflammatory bowel disease (IBD) burden has rapidly increased recently, but the epidemiological trends in Asia remain unclear. We report IBD's incidence, prevalence, mortality, and Disability-Adjusted Life Years (DALY) in 52 Asian countries from 1990 to 2019. METHODS Data from the Global Burden of Disease 2019 were analyzed for IBD burden across 52 countries, using metrics like incidence, prevalence, mortality rates, and DALY. The epidemiological trend of IBD from 1990 to 2019 was assessed with the Joinpoint and APC methods. Decomposition and frontier analyses examined factors behind IBD case and death changes. The NORPRED forecasted Asia's morbidity and mortality trends from 2019 to 2044. RESULTS From 1990 to 2019, The incidence and prevalence of IBD increased in Asia, while mortality and DALY decreased. East Asia had the highest increase in disease burden. IBD incidence was highest among the 30-34 age group, with prevalence peaking in the 45-49 age group. In high-income regions, IBD peak age shifted to younger groups. Decompose analysis showed population growth as the primary factor for the increasing IBD cases in Asia. NORDPRED model predicted a continued IBD burden increase in Asia over the next 25 years. CONCLUSIONS Between 1990 and 2019, ASIR and ASPR of IBD in Asia increased, while ASMR and ASDR decreased. Due to population growth and aging, the IBD burden is expected to rise over the next 25 years, particularly in East Asia.
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Affiliation(s)
- Xuejie Chen
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Xin Xiang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Weitong Xia
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Xindi Li
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Sidan Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Shuyu Ye
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Li Tian
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Lian Zhao
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Feiyan Ai
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Zhaohua Shen
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Kai Nie
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Minzi Deng
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China.
| | - Xiaoyan Wang
- Department of Gastroenterology, The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China.
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Zhang ZM, Lin ZL, He BX, Yan WT, Zhang XY, Zhang ZH, Wang L, Wang JQ, Liu DM, Zhang W, Li ZH. Epidemiological analysis reveals a surge in inflammatory bowel disease among children and adolescents: A global, regional, and national perspective from 1990 to 2019 - insights from the China study. J Glob Health 2023; 13:04174. [PMID: 38037705 PMCID: PMC10690112 DOI: 10.7189/jogh.13.04174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
Background The burden of inflammatory bowel disease (IBD) among children and adolescents is rising globally, with substantial variation in levels and trends of disease in different countries and regions, while data on the burden and trends were sparse in children and adolescents. We aimed to assess the trends and geographical differences in children and adolescents aged zero to 19 in 204 countries and territories over the past 30 years. Methods Data on IBD among children and adolescents was collected from the Global Burden of Disease (GBD) 2019 database from 1990 to 2019. We used the GBD data and methodologies to describe the change in the burden of IBD among children and adolescents involving prevalence, incidence, disability-adjusted life years (DALYs), and mortality. Results Globally, the IBD prevalence cases increased between 1990 and 2019. Annual percentage changes (AAPC) = 0.15; 95% confidence interval (CI) = 0.11-0.19, and incidence cases of IBD increased from 20 897.4 (95% CI = 17 008.6-25 520.2 in 1990 to 25 658.6 (95% CI = 21 268.5-31 075.6) in 2019, representing a 22.78% increase, DALYs cases decreased between 1990 and 2019 (AAPC = -3.02; 95% CI = -3.15 to -2.89), and mortality cases of IBD decreased from 2756.5 (95% CI = 1162.6-4484.9) in 1990 to 1208.0 (95% CI = 802.4-1651.4) in 2019, representing a 56.17% decrease. Decomposition analysis showed that IBD prevalence and incidence increased significantly, and a trend exhibited a decrease in underlying age and population-adjusted IBD DALYs and mortality rates. Correlation analysis showed that countries with high health care quality and access (HAQ) had relatively higher IBD age-standardised prevalence rate (ASPR) and age-standardised incidence rate (ASIR), but lower age-standardised DALYs rate (ASDR) and age-standardised mortality rate (ASMR). Conclusions Global prevalence and incidence rate of IBD among children and adolescents have been increasing from 1990 to 2019, while the DALYs and mortality have been decreasing. Rising prevalence and rising incidence in areas with historically low rates will have crucial health and economic implications.
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Affiliation(s)
- Zhong-mian Zhang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zi-li Lin
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Bai-xiang He
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei-tian Yan
- Rheumatology Department, Yunnan Provincial Hospital of Traditional Chinese Medicine, Yunnan University of Chinese Medicine, Yunnan, China
| | - Xi-yan Zhang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhong-han Zhang
- College of Psychology and Mental Health, North China University of Science and Technology, Hebei, China
| | - Lan Wang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jia-qi Wang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Da-ming Liu
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wen Zhang
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhi-hong Li
- Department of Gastroenterology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Li CJ, Wang YK, Zhang SM, Ren MD, He SX. Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast. World J Gastroenterol 2023; 29:5751-5767. [PMID: 38075848 PMCID: PMC10701338 DOI: 10.3748/wjg.v29.i42.5751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039. AIM To comprehensively investigate IBD data, providing further insights into the management of this chronic disease. METHODS We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1). RESULTS North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases. CONCLUSION As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.
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Affiliation(s)
- Cheng-Jun Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi-Kai Wang
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Shun-Ming Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, Shaanxi Province, China
| | - Mu-Dan Ren
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shui-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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Li CJ, Wang YK, Zhang SM, Ren MD, He SX. Global burden of inflammatory bowel disease 1990-2019: A systematic examination of the disease burden and twenty-year forecast. World J Gastroenterol 2023; 29:5764-5780. [DOI: 10.3748/wjg.v29.i42.5764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is an idiopathic intestinal disease with various levels and trends in different countries and regions. Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment. We report the average annual percentage change (AAPC) and estimated annual percentage change (EAPC) in age-standardized rates (ASR) of IBD in different regions based on the Global Burden of Disease (GBD) study from 1990-2019, and the relationships between IBD and the human development index (HDI) and socio-demographic index (SDI). The prevalence trends of IBD were predicted by gender from 2019-2039.
AIM To comprehensively investigate IBD data, providing further insights into the management of this chronic disease.
METHODS We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions. The relationships between IBD, HDI, and SDI were analyzed. The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039, and the reliability of the results was validated. Statistics of all the data in this study were performed using R software (version 4.2.1).
RESULTS North America consistently had the highest IBD ASR, while Oceania consistently had the lowest. East Asia had the fastest average annual growth in ASR (2.54%), whereas Central Europe had the fastest decline (1.38%). Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019. Additionally, IBD increased faster in countries with a low age-standardized death rates in 1990, whereas the opposite was true in 2019. Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR. Finally, the projections showed a declining trend in the incidence of IBD from 2019-2039, but a gradual increase in the number of cases.
CONCLUSION As the global population increases and ages, early monitoring and prevention of IBD is important to reduce the disease burden, especially in countries with a high incidence of IBD.
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Affiliation(s)
- Cheng-Jun Li
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Yi-Kai Wang
- Department of Infectious Diseases, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
| | - Shun-Ming Zhang
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an 710061, Shaanxi Province, China
| | - Mu-Dan Ren
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Shui-Xiang He
- Department of Gastroenterology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
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Wang F, Hu D, Sun H, Yan Z, Wang Y, Wang L, Zhang T, Meng N, Zhai C, Zong Q, Hu W, Yu G, Zou Y. Global, regional, and national burden of digestive diseases: findings from the global burden of disease study 2019. Front Public Health 2023; 11:1202980. [PMID: 37693711 PMCID: PMC10483149 DOI: 10.3389/fpubh.2023.1202980] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
Background The global burden of digestive diseases has been rising in the last 30 years. The rates and trends of incidence, deaths, and disability-adjusted life-years (DALYs) for digestive diseases need to be investigated. Methods We extracted the data on overall digestive diseases and by cause between 1990-2019 from the Global Burden of Diseases 2019 website, including the absolute number and the corresponding age-standardized rates of incidence (ASIR), deaths (ASDR), and DALYs (ASDALYs). Results Globally, the incident cases, deaths, and DALYs of digestive diseases in 2019 increased by 74.44, 37.85, and 23.46%, respectively, compared with that in 1990, with an increasing ASIR of 0.09%, as well as decreasing ASDR and ASDALYs of 1.38 and 1.32% annually. The sociodemographic index (SDI) of overall digestive diseases showed a slight increase in ASIR from low to middle-low regions. The downtrend in ASDR and ASDALYs was found in all SDI regions. The burden of incidence was higher in females, while the burden of deaths and DALYs was higher in males for the overall digestive diseases and most causes. The estimated annual percentage changes were significantly associated with the baseline ASIR, ASDR, and ASDALYs for the overall digestive diseases, and the negative correlations between ASDR, ASDALYs, and human development index both in 1990 (R = -0.68, R = -0.69) and 2019 (R = -0.71, R = -0.73) were noticed. Conclusion The findings indicate that digestive diseases remain a significant public health burden, with substantial variation across countries, sexes, and age groups. Therefore, implementing age, gender, and country-specific policies for early screening and targeted interventions could significantly reduce the global burden of digestive diseases.
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Affiliation(s)
- Fang Wang
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dingtao Hu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Clinical Cancer Institute, Center for Translational Medicine, Second Military Medical University, Shanghai, China
| | - Hongyu Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Ziye Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yuhua Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Linlin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Tingyu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Nana Meng
- Department of Quality Management Office, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Chunxia Zhai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qiqun Zong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Wanqin Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Guanghui Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Yanfeng Zou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Wetwittayakhlang P, Gonczi L, Golovics PA, Kurti Z, Pandur T, David G, Erdelyi Z, Szita I, Lakatos L, Lakatos PL. Time Trends of Environmental and Socioeconomic Risk Factors in Patients with Inflammatory Bowel Disease over 40 Years: A Population-Based Inception Cohort 1977-2020. J Clin Med 2023; 12:jcm12083026. [PMID: 37109362 PMCID: PMC10147007 DOI: 10.3390/jcm12083026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/04/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Data from population-based studies investigating trends in environmental factors associated with inflammatory bowel disease (IBD) is lacking. We aimed to assess long-term time trends of environmental and socioeconomic factors in IBD patients from a well-defined population-based cohort from Veszprem, Hungary. METHODS Patients were included between 1 January 1977, and 31 December 2020. Trends of environmental and socioeconomic factors were evaluated in three periods based on the decade of diagnosis, representing different therapeutic eras: cohort-A,1977-1995; cohort-B,1996-2008 (immunomodulator era); and cohort-C, 2009-2020 (biological era). RESULTS A total of 2240 incident patients with IBD were included (ulcerative colitis (UC) 61.2%, male 51.2%, median age at diagnosis: 35 years (IQR 29-49)). Rates of active smoking significantly decreased over time in Crohn's disease (CD): 60.2%, 49.9%, and 38.6% in cohorts A/B/C (p < 0.001). In UC, the rates were low and stable: 15.4%, 15.4%, and 14.5% in cohorts A/B/C (p = 0.981). Oral contraceptive use was more common in CD compared to UC (25.0% vs. 11.6%, p < 0.001). In UC, prevalence of appendectomy before diagnosis decreased over time: 6.4%, 5.5%, and 2.3% in cohorts A/B/C (p = 0.013). No significant changes were found in the socio-geographic characteristics of the IBD population (urban living: UC, 59.8%/64.8%/ 62.5% (p = 0.309) and CD, 62.5%/ 62.0%/ 59.0% (p = 0.636), in cohorts A/B/C). A greater percentage of patients had completed secondary school as the highest education level in later cohorts in both UC (42.9%/50.2%/51.6%, p < 0.001) and CD (49.2%/51.7%/59.5%, p = 0.002). A higher percentage of skilled workers (34.4%/36.2%/38.9%, p = 0.027) was found in UC, but not in CD (p = 0.454). CONCLUSION The association between trends of known environmental factors and IBD is complex. Smoking has become less prevalent in CD, but no other major changes occurred in socioeconomic factors over the last four decades that could explain the sharp increase in IBD incidence.
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Affiliation(s)
- Panu Wetwittayakhlang
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Thailand
| | - Lorant Gonczi
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Petra A Golovics
- Department of Gastroenterology, Hungarian Defence Forces Medical Centre, 1062 Budapest, Hungary
| | - Zsuzsanna Kurti
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
| | - Tunde Pandur
- Department of Gastroenterology, Grof Eszterhazy Hospital, 8500 Papa, Hungary
| | - Gyula David
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Zsuzsanna Erdelyi
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Istvan Szita
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Laszlo Lakatos
- Department of Gastroenterology, Ferenc Csolnoky Hospital, 8200 Veszprem, Hungary
| | - Peter L Lakatos
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
- Department of Internal Medicine and Oncology, Semmelweis University, 1083 Budapest, Hungary
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11
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Ceccarelli E, Minelli G, Egidi V, Jona Lasinio G. Assessment of Excess Mortality in Italy in 2020-2021 as a Function of Selected Macro-Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2812. [PMID: 36833508 PMCID: PMC9956038 DOI: 10.3390/ijerph20042812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Excess mortality (EM) can reliably capture the impact of a pandemic, this study aims at assessing the numerous factors associated with EM during the COVID-19 pandemic in Italy. METHODS Mortality records (ISTAT 2015-2021) aggregated in the 610 Italian Labour Market Areas (LMAs) were used to obtain the EM P-scores to associate EM with socioeconomic variables. A two-step analysis was implemented: (1) Functional representation of EM and clustering. (2) Distinct functional regression by cluster. RESULTS The LMAs are divided into four clusters: 1 low EM; 2 moderate EM; 3 high EM; and 4 high EM-first wave. Low-Income showed a negative association with EM clusters 1 and 4. Population density and percentage of over 70 did not seem to affect EM significantly. Bed availability positively associates with EM during the first wave. The employment rate positively associates with EM during the first two waves, becoming negatively associated when the vaccination campaign began. CONCLUSIONS The clustering shows diverse behaviours by geography and time, the impact of socioeconomic characteristics, and local governments and health services' responses. The LMAs allow to draw a clear picture of local characteristics associated with the spread of the virus. The employment rate trend confirmed that essential workers were at risk, especially during the first wave.
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Affiliation(s)
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, 00161 Rome, Italy
| | - Viviana Egidi
- Department of Statistical Sciences, La Sapienza University, 00185 Rome, Italy
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12
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Hepatobiliary Impairments in Patients with Inflammatory Bowel Diseases: The Current Approach. GASTROENTEROLOGY INSIGHTS 2022. [DOI: 10.3390/gastroent14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Inflammatory bowel disease (IBD) refers to chronic conditions with a low mortality but high disability. The multisystemic nature of these diseases can explain the appearance of some extraintestinal manifestations, including liver damage. Abnormal liver biochemical tests can be identified in approximately one third of patients with IBD and chronic liver disease in 5% of them. Among the liver diseases associated with IBD are primary sclerosing cholangitis, cholelithiasis, fatty liver disease, hepatic amyloidosis, granulomatous hepatitis, drug-induced liver injury, venous thromboembolism, primary biliary cholangitis, IgG4-related cholangiopathy, autoimmune hepatitis, liver abscesses or the reactivation of viral hepatitis. The most common disease is primary sclerosing cholangitis, a condition diagnosed especially in patients with ulcerative colitis. The progress registered in recent years in the therapeutic management of IBD has not eliminated the risk of drug-induced liver disease. Additionally, the immunosuppression encountered in these patients increases the risk of opportunistic infections, including the reactivation of viral hepatitis. Currently, one of the concerns consists of establishing an efficiency and safety profile of the use of direct-acting antiviral agents (DAA) among patients with hepatitis C and IBD. Early diagnosis and optimal treatment of liver complications can improve the prognoses of these patients.
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13
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Rønnow Sand J, Troelsen FS, Horváth‐Puhó E, Henderson VW, Sørensen HT, Erichsen R. Risk of dementia in patients with inflammatory bowel disease: a Danish population-based study. Aliment Pharmacol Ther 2022; 56:831-843. [PMID: 35781292 PMCID: PMC9545113 DOI: 10.1111/apt.17119] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/07/2022] [Accepted: 06/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) may be associated with increased dementia risk, but the literature is conflicting. AIM To investigate dementia risk in patients with IBD. METHODS We conducted a nationwide population-based cohort study in Denmark (1977-2018) including all patients with incident IBD matched with up to 10 general population comparators without IBD by sex, year of birth and region of residence. We calculated cumulative incidence proportions (CIPs) of dementia treating death as a competing risk, and adjusted hazard ratios (HRs) comparing IBD patients with matched comparisons. In a nested case-control analysis, we investigated the impact of IBD severity, steroid use, colorectal and small bowel surgery, and healthcare system contacts on dementia risk. RESULTS Of 88,985 patients with IBD (69.6% with ulcerative colitis [UC], 30.4% with Crohn's disease [CD]) and 884,108 comparisons, 2076 patients (78.1% with UC) and 23,011 comparisons (76.6% UC comparisons) developed dementia. The 40-year CIP of all-cause dementia was 7.2% for UC patients and 5.8% for CD patients. UC patients had a slightly increased HR of all-cause dementia (HR = 1.07 [95% confidence interval (CI): 1.01;1.12]) and Alzheimer's disease (HR = 1.10 [95% CI: 1.01-1.19]). CD patients had an increased HR of all-cause dementia (HR = 1.15 [95% CI: 1.05-1.27]) and frontotemporal dementia (HR = 2.70 [95% CI: 1.44-5.05]). Dementia in IBD patients was associated with frequent healthcare system contacts. CONCLUSIONS UC and CD are associated with slightly increased all-cause dementia risk, particularly frontotemporal dementia in CD patients. Frequent healthcare system contacts by patients with IBD and detection bias may play a role in the association.
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Affiliation(s)
- Jakob Rønnow Sand
- Department of Clinical EpidemiologyAarhus University Hospital and Clinical Institute of Arhus UniversityAarhus NDenmark
| | | | - Erzsébet Horváth‐Puhó
- Department of Clinical EpidemiologyAarhus University Hospital and Clinical Institute of Arhus UniversityAarhus NDenmark
| | - Victor W. Henderson
- Department of Clinical EpidemiologyAarhus University Hospital and Clinical Institute of Arhus UniversityAarhus NDenmark,Departments of Epidemiology and Population Health and of Neurology and Neurological SciencesStanford UniversityStanfordCaliforniaUSA
| | - Henrik Toft Sørensen
- Department of Clinical EpidemiologyAarhus University Hospital and Clinical Institute of Arhus UniversityAarhus NDenmark
| | - Rune Erichsen
- Department of Clinical EpidemiologyAarhus University Hospital and Clinical Institute of Arhus UniversityAarhus NDenmark,Department of SurgeryRanders Regional HospitalRandersDenmark
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14
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Henderson P. Editorial: earning potential in paediatric-onset IBD-a complex interplay. Aliment Pharmacol Ther 2022; 56:1084-1085. [PMID: 35995735 DOI: 10.1111/apt.17169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Paul Henderson
- Child Life and Health, University of Edinburgh, Edinburgh, UK.,Department of Paediatric Gastroenterology and Nutrition, Royal Hospital for Children and Young People, Edinburgh, UK
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15
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Malmborg P, Everhov ÅH, Söderling J, Ludvigsson JF, Bruze G, Olén O. Earnings during adulthood in patients with childhood-onset inflammatory bowel disease: a nationwide population-based cohort study. Aliment Pharmacol Ther 2022; 56:1007-1017. [PMID: 35916469 PMCID: PMC9544615 DOI: 10.1111/apt.17148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND IBD with onset during childhood seems to represent a severe disease phenotype with increased morbidity. We have previously demonstrated that children with IBD have significantly lower final grades in compulsory school compared to healthy peers. AIM To evaluate the association of childhood-onset IBD with a later professional career and subsequent earnings METHODS: We identified 5404 individuals diagnosed with childhood-onset (<18 years) IBD between 1990 and 2014 (2818 with ulcerative colitis and 2328 with Crohn's disease) in the Swedish National Patient Register. Patients were matched with 10 general population reference individuals by sex, birth year, and place of residence (n = 51,295). Data on earnings during 1992-2017 were obtained through the longitudinal integration database for health insurance and labour market studies. Earnings were converted into Euros (inflation-adjusted to 2019). The differences in earnings between patients and general population reference individuals were calculated through quantile regression. RESULTS Patients with childhood-onset IBD had significantly lower annual taxable earnings from ages 20 to 30 (adjusted median annual income difference (AMAID) at age 30: -5.4% [95% CI -9.1% to -1.8%]). In particular, annual taxable earnings through early adult age were lower in patients who, during childhood, had had surgery or long-term inpatient treatment for IBD (AMAID at age 30: -16.3% [95% CI -24.7% to -7.9%]). CONCLUSIONS Overall, the negative influence of disease on earnings in early adult age was modest for patients with childhood-onset IBD. The markedly larger negative income gap from ages 20 to 30 in patients with more severe IBD during childhood should be recognised.
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Affiliation(s)
- Petter Malmborg
- Sachs' Children and Youth HospitalStockholmSweden,Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden,Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Åsa H. Everhov
- Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden,Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Jonas Söderling
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Department of PaediatricsÖrebro University HospitalÖrebroSweden,Division of Epidemiology and Public HealthSchool of Medicine, University of NottinghamNottinghamUK,Columbia universityNew York CityNew YorkUSA
| | - Gustaf Bruze
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Ola Olén
- Sachs' Children and Youth HospitalStockholmSweden,Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden,Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
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16
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Abstract
Complementary and alternative medicine (CAM) is a growing entity within inflammatory bowel disease (IBD). CAM includes mind-based therapies, body-based therapies, supplements, vitamins, and probiotics. Limitations currently exist for health care providers as it pertains to IBD and CAM that stem from knowledge gaps, conflicting reports, limited oversight, and a lack of well-organized clinical data. Even without well-described data, patients are turning to these forms of therapy at increasing rates. It is imperative that the ongoing review of CAM therapies is performed, and future trials are performed to better understand efficacy as well as adverse effects related to these therapies.
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17
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Delaroque C, Chervy M, Gewirtz AT, Chassaing B. Social overcrowding impacts gut microbiota, promoting stress, inflammation, and dysglycemia. Gut Microbes 2022; 13:2000275. [PMID: 34856844 PMCID: PMC8726700 DOI: 10.1080/19490976.2021.2000275] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
An array of chronic inflammatory diseases, including metabolic diseases such as obesity and diabetes, are thought to be promoted by disturbance of the intestinal microbiota. Such diseases disproportionately impact low-income communities, which are frequently afflicted by chronic stress and increased density housing. Hence, we hypothesized that overcrowded housing might promote stress, microbiota dysbiosis, inflammation, and, consequently, metabolic diseases. We tested this hypothesis in a tractable murine model of social overcrowding (SOC), in which mice were housed at twice normal density. SOC moderately impacted behavior in some widely used assays (Open Field, Elevated Plus Maze and Light/Dark tests) and resulted in a stark increase in corticosterone levels. Such indices of stress were associated with mild chronic gut inflammation, hyperglycemia, elevations in colonic cytokines, and alterations in gut microbiota composition. All of these consequences of SOC were eliminated by broad spectrum antibiotics, while some (inflammation and hyperglycemia) were transmitted by microbiota transplantation from SOC mice to germfree mice housed at normal density. Altogether, these results suggest a central role for intestinal microbiota in driving stress, inflammation, and chronic diseases that are promoted by overcrowded housing.
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Affiliation(s)
- Clara Delaroque
- Inserm U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, Cnrs Umr 8104, Université de Paris, Paris, France
| | - Mélissa Chervy
- Université Clermont Auvergne, Inserm U1071; Usc-inrae 2018, Microbes, Intestin, Inflammation Et Susceptibilité de l’Hôte (M2ish), 28 Place Henri Dunant, Clermont-Ferrand, France
| | - Andrew T. Gewirtz
- Center for Inflammation, Immunity and Infection, Institute for Biomedical Sciences, Georgia State University, GeorgiaCalifornia, USA
| | - Benoit Chassaing
- Inserm U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases”, Cnrs Umr 8104, Université de Paris, Paris, France,CONTACT Benoit Chassaing Inserm, U1016, Team “Mucosal Microbiota in Chronic Inflammatory Diseases” Paris, France
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18
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Langbrandtner J, Steimann G, Reichel C, Bokemeyer B, Hüppe A. [Inflammatory Bowel Disease - Challenges in the Workplace and Support for Coping with Disease]. REHABILITATION 2021; 61:97-106. [PMID: 34544161 DOI: 10.1055/a-1581-6497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Patients with inflammatory bowel diseases (IBD) are often impaired in their ability to be employed due to IBD symptoms. The aim of this study was to explore work-related problems and support requested by IBD patients and develop rehabilitation programs meeting their needs. METHODS A total of 235 IBD patients (97 rehabilitants, 138 outpatients) completed a questionnaire assessing disease-specific impairments, work-related concerns and the need for support services. Subjective work disability was determined with the SPE scale. RESULTS Participants were on average 46 years old, 60% were women, 45% suffered from Crohn's disease and 67% worked full-time; 72% (n=170) had a negative subjective prognosis of gainful employment. Participants reported an average of 12 disease-specific and 22 work-related problems. About 50% of the participants reported disease-specific problems, namely fatigue (66%), weakness (55%) and urge to pass stool (55%). The three most common work-related problems affecting more than 50% of the respondents almost every day were reduced work ability (56%), worrying about not being fully efficient (55%) and stress at work (53%). Support services requested were counselling for information on the disease (91%), treatment options (88%), social law benefits (85%) and exercises to increase physical fitness (84%). CONCLUSION The wide range of work-related physical and psychosocial impairments affecting IBD patients reveals a need to extend current rehabilitation services, with a stronger occupational focus and to implement a standardized screening for work-related problems. Disease-specific support services can be developed and addressed in a multimodal and interdisciplinary setting such as the rehabilitation sector.
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Affiliation(s)
- Jana Langbrandtner
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck
| | | | - Christoph Reichel
- Reha-Zentrum Bad Brückenau, Klinik Hartwald, Bad Brückenau.,Institut für Hygiene und Öffentliche Gesundheit/Public Health, Universität Bonn, Bonn
| | | | - Angelika Hüppe
- Institut für Sozialmedizin und Epidemiologie, Universität zu Lübeck, Lübeck
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19
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Nguyen NH, Khera R, Ohno-Machado L, Sandborn WJ, Singh S. Prevalence and Effects of Food Insecurity and Social Support on Financial Toxicity in and Healthcare Use by Patients With Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2021; 19:1377-1386.e5. [PMID: 32526341 PMCID: PMC7987215 DOI: 10.1016/j.cgh.2020.05.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We estimated the prevalence of social determinants of health (SDH, food insecurity and social support) in adults with inflammatory bowel diseases (IBD) in the United States and evaluated associations with financial toxicity and healthcare use. METHODS In the National Health Interview Survey 2015, we identified adults with IBD and estimated the prevalence of food insecurity and/or lack of social support. We evaluated associations with financial toxicity (financial hardship due to medical bills, personal and health-related financial distress, cost-related medication nonadherence, healthcare affordability) and emergency department use. RESULTS Of estimated 3.1 million adults with IBD in the US, 42% or estimated 1,277,215 patients with IBD reported at least one negative SDH, with 12% reporting both food insecurity and lack of social support. On multivariable analysis adjusting for age, sex, race, family income and comorbidities, patients with food insecurity were significantly more likely to experience financial hardship due to medical bills (odds ratio [OR], 3.31; 95% CI, 1.48-7.39), financial distress (OR, 6.92; 95% CI, 2.28-21.0) and cost-related medication non-adherence (OR, 8.07; 95% CI, 3.16-20.6). Similarly, patients with inadequate social support were significantly more likely to experience financial hardship due to medical bills (OR, 2.98; 95% CI, 1.56-5.67), financial distress (OR, 3.05; 95% CI, 1.64-5.67) and cost-related medication non-adherence (OR, 2.71; 95% CI, 1.10-6.66). Food insecurity and/or lack of social support was not associated with increased risk of emergency department use. CONCLUSIONS In an analysis of data from the National Health Interview Survey 2015, we found that 1 in 8 patients with IBD have food insecurity and lack social support, which is associated with higher financial toxicity. Patients with IBD should be assessed for SDH to tailor healthcare delivery and improve population health.
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Affiliation(s)
- Nghia H. Nguyen
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lucila Ohno-Machado
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California
| | - William J. Sandborn
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California
| | - Siddharth Singh
- Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, California; Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California.
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20
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Copeland JK, Chao G, Vanderhout S, Acton E, Wang PW, Benchimol EI, El-Sohemy A, Croitoru K, Gommerman JL, Guttman DS. The Impact of Migration on the Gut Metagenome of South Asian Canadians. Gut Microbes 2021; 13:1-29. [PMID: 33794735 PMCID: PMC8023248 DOI: 10.1080/19490976.2021.1902705] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 02/04/2023] Open
Abstract
South Asian (SA) Canadian immigrants have a higher risk of developing certain immune-mediated inflammatory diseases compared to non-migrant SAs. We sought to investigate the effect of migration on the gut metagenome and to identify microbiological associations between migration and conditions that may influence the development of immune-mediated inflammatory diseases. Metagenomic analysis of 58 first-generation (GEN1) SA immigrants and 38 unrelated Canadian born children-of-immigrants (GEN2) determined that the time lived in Canada was associated with continued changes in gut microbial communities. Migration of GEN1 to Canada early in life results in a gut community with similarities to GEN2 SA Canadians and non-SA North Americans. Conversely, GEN1 immigrants who arrived recently to Canada exhibited pronounced differences from GEN2, while displaying microbial similarities to a non-migrating SA cohort. Multivariate analysis identified that community composition was primarily influenced by high abundance taxa. Prevotella copri dominated in GEN1 and non-migrant SAs. Clostridia and functionally related Bacteroidia spp. replaced P. copri dominance over generations in Canada. Mutually exclusive Dialister species occurred at differing relative abundances over time and generations in Canada. This shift in species composition is accompanied by a change in genes associated with carbohydrate utilization and short-chain fatty acid production. Total energy derived from carbohydrates compared to protein consumption was significantly higher for GEN1 recent immigrants, which may influence the functional requirements of the gut community. This study demonstrates the associations between migration and the gut microbiome, which may be further associated with the altered risk of immune-mediated inflammatory diseases observed for SA Canadians.
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Affiliation(s)
- Julia K. Copeland
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
| | - Gary Chao
- Department of Immunology, University of Toronto, Toronto, CA, Canada
| | - Shelley Vanderhout
- Nutrigenomix, Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
| | - Erica Acton
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
| | - Pauline W. Wang
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, CA, Canada
| | - Eric I. Benchimol
- Department of Pediatrics, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, CA, Canada
| | - Ahmed El-Sohemy
- Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
| | - Ken Croitoru
- Department of Medicine, University of Toronto and Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, CA, Canada
| | | | - David S. Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, CA, Canada
| | - the GEMINI Research Team
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto, CA, Canada
- Department of Immunology, University of Toronto, Toronto, CA, Canada
- Nutrigenomix, Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, CA, Canada
- Department of Pediatrics, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, CA, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, CA, Canada
- Department of Medicine, University of Toronto and Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, CA, Canada
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21
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Everhov ÅH, Bruze G, Söderling J, Askling J, Halfvarson J, Westberg K, Malmborg P, Nordenvall C, Ludvigsson JF, Olén O. Women's Earnings are more Affected by Inflammatory Bowel Disease than Men's: A Register-Based Swedish Cohort Study. J Crohns Colitis 2020; 15:980-987. [PMID: 33245360 PMCID: PMC8218710 DOI: 10.1093/ecco-jcc/jjaa238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Patients with inflammatory bowel disease [IBD] are subject to more work disability than the general population. We aimed to estimate the monetary cost of IBD for the individual through assessment of earnings in relation to diagnosis. METHODS Through linkage of national registers, we identified patients aged 30-55 years at first IBD diagnosis in Sweden in 2002-2011, and same-sex IBD-free siblings. We estimated taxable earnings and disposable income from 5 years before to 5 years after diagnosis. RESULTS The 5961 patients [27% Crohn's disease, 68% ulcerative colitis, 4.3% IBD unclassified] had similar taxable earnings to their 7810 siblings until the year of diagnosis, when earnings decreased and remained lower than for siblings during follow-up. The adjusted difference in earnings over the entire 5-year period after diagnosis was -5% [-8212€; 95% confidence interval: -11 458 to -4967€]. The difference was greater in women than in men, and greater in Crohn's disease than in ulcerative colitis. When stratifying for sex and IBD subtype and comparing earnings during each year of follow-up, median annual earnings were lower in women with Crohn's disease and ulcerative colitis than in their sisters during all years of follow-up, whereas the men had similar annual taxable earnings to their brothers. Disposable income was similar between patients and siblings during the investigated time period. CONCLUSION From the year of diagnosis and at least 5 years onwards, patients with IBD had 5% lower earnings than siblings, mainly explained by differences between women with IBD and their sisters. However, there were no differences in disposable income.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Corresponding author: Åsa H. Everhov, Department of Surgery, Stockholm South General Hospital, SE 118 61 Stockholm, Sweden. Tel: +46 8-6162349;
| | - Gustaf Bruze
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karin Westberg
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Division of Surgery, Danderyd Hospital, Stockholm, Sweden
| | - Petter Malmborg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Pediatric Gastroenterology and Nutrition, Sachs’ Children and Youth Hospital, Stockholm, Sweden
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22
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Alatab S, Sepanlou SG, Ikuta K, Vahedi H, Bisignano C, Safiri S, Sadeghi A, Nixon MR, Abdoli A, Abolhassani H, Alipour V, Almadi MAH, Almasi-Hashiani A, Anushiravani A, Arabloo J, Atique S, Awasthi A, Badawi A, Baig AAA, Bhala N, Bijani A, Biondi A, Borzì AM, Burke KE, Carvalho F, Daryani A, Dubey M, Eftekhari A, Fernandes E, Fernandes JC, Fischer F, Haj-Mirzaian A, Haj-Mirzaian A, Hasanzadeh A, Hashemian M, Hay SI, Hoang CL, Househ M, Ilesanmi OS, Jafari Balalami N, James SL, Kengne AP, Malekzadeh MM, Merat S, Meretoja TJ, Mestrovic T, Mirrakhimov EM, Mirzaei H, Mohammad KA, Mokdad AH, Monasta L, Negoi I, Nguyen TH, Nguyen CT, Pourshams A, Poustchi H, Rabiee M, Rabiee N, Ramezanzadeh K, Rawaf DL, Rawaf S, Rezaei N, Robinson SR, Ronfani L, Saxena S, Sepehrimanesh M, Shaikh MA, Sharafi Z, Sharif M, Siabani S, Sima AR, Singh JA, Soheili A, Sotoudehmanesh R, Suleria HAR, Tesfay BE, Tran B, Tsoi D, Vacante M, Wondmieneh AB, Zarghi A, Zhang ZJ, Dirac M, Malekzadeh R, Naghavi M. The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5:17-30. [PMID: 31648971 PMCID: PMC7026709 DOI: 10.1016/s2468-1253(19)30333-4] [Citation(s) in RCA: 1201] [Impact Index Per Article: 300.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. METHODS We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI). FINDINGS In 2017, there were 6·8 million (95% UI 6·4-7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9-83·5) per 100 000 population in 1990 to 84·3 (79·2-89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55-0·69) per 100 000 population in 1990 to 0·51 (0·42-0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 [398·7-446·1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 [6·3-7·2] per 100 000 population). High Socio-demographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464·5 [438·6-490·9] per 100 000 population), followed by the UK (449·6 [420·6-481·6] per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1·8 [0·8-3·2] per 100 000 population) and Singapore had the lowest (0·08 [0·06-0·14] per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0·56 million (0·39-0·77) in 1990 to 1·02 million (0·71-1·38) in 2017. The age-standardised rate of DALYs decreased from 26·5 (21·0-33·0) per 100 000 population in 1990 to 23·2 (19·1-27·8) per 100 000 population in 2017. INTERPRETATION The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. FUNDING Bill & Melinda Gates Foundation.
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23
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Lo B, Vind I, Vester-Andersen MK, Bendtsen F, Burisch J. Direct and Indirect Costs of Inflammatory Bowel Disease: Ten Years of Follow-up in a Danish Population-based Inception Cohort. J Crohns Colitis 2020; 14:53-63. [PMID: 31076743 DOI: 10.1093/ecco-jcc/jjz096] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Inflammatory bowel disease [IBD], encompassing Crohn's disease [CD] and ulcerative colitis [UC], places a high burden on health care resources. To date, no study has assessed the combined direct and indirect cost of IBD in a population-based setting. Our aim was to assess this in a population-based inception cohort with 10 years of follow-up. METHODS All incident patients diagnosed with CD or UC, 2003-2004, in a well-defined area of Copenhagen, were followed prospectively until 2015. Direct and indirect costs were retrieved from Danish national registries. Data were compared with a control population [1:20]. Associations between the costs and multiple variables were assessed. RESULTS A total of 513 (CD: 213 [42%], UC: 300 [58%]) IBD patients were included. No significant differences were found in indirect costs between CD, UC, and the control population. Costs for CD patients were significantly higher than those for UC regarding all direct expenditures (except for5-aminosalicylates [5-ASA] and diagnostic expenses). Biologics accounted for €1.6 and €0.3 million for CD and UC, respectively. The total costs amounted to €42.6 million. Only patients with extensive colitis had significantly higher direct costs (proctitis: €2273 [1341-4092], left-sided: €3606 [2354-5311], extensive: €4093 [2313-6057], p <0.001). No variables were significantly associated with increased total costs in CD or in UC patients. CONCLUSIONS In this prospective population-based cohort, direct costs for IBD remain high. However, indirect costs did not surpass the control population. Total costs were mainly driven by hospitalisation, but indirect costs accounted for a higher percentage overall, although these did decrease over time. PODCAST This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast.
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Affiliation(s)
- Bobby Lo
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ida Vind
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Marianne Kajbaek Vester-Andersen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Medical Department, Zealand University Hospital, Koege, Denmark
| | - Flemming Bendtsen
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Johan Burisch
- Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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24
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Neighborhood Deprivation and Risks of Autoimmune Disorders: A National Cohort Study in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203798. [PMID: 31601008 PMCID: PMC6843782 DOI: 10.3390/ijerph16203798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 11/24/2022]
Abstract
Background: No study to date, as far as we know, has analyzed the potential effect of neighborhood-level deprivation on autoimmune disorders (ADs), when adjusted for individual-level characteristics. Methods: A total of 5.4 million individuals from 8363 neighborhoods, comprising the whole Swedish population (ages 25–74 years), were followed for the period 1 January 2000, until admission due to diagnosis of ADs during the period of the study, or the conclusion of the study (31 December 2010). We used a neighborhood deprivation index, constructed from variables such as low education, low income, unemployment, and social welfare assistance, to assess the level of neighborhood deprivation. Multilevel logistic regression was used in the analysis with individual level characteristics at the first level and level of neighborhood deprivation at the second level. Results: A significant association between level of neighborhood deprivation and ADs was found. The crude odds were 1.32 (95% confidence interval 1.27–1.36) for those residing in the high-deprived neighborhoods compared to those living in low-deprivation neighborhoods. In the full model, where individual level characteristics were taken into account, the odds of ADs were 1.18 (1.14–1.22) in the most deprived neighborhoods. Certain Ads—angiitis hypersensitive (5.14), ankylosing spondylitis (1.66), celiac disease (1.65), Crohn’s disease (1.21), diabetes mellitus type 1 (1.45), Graves’s disease (1.13), Hashimoto thyroiditis (1.51), psoriasis (1.15), rheumatoid arthritis (1.15), sarcoidosis (1.20), and systemic sclerosis (1.27)—remained significantly associated with high level of neighborhood deprivation after adjustment for the individual-level variables. Conclusion: This study is the largest to date analyzing the potential influence of neighborhood deprivation on ADs. Our results indicate that neighborhood deprivation may affect risk of ADs, independent of individual level sociodemographic characteristics. For health care policies, both individual and neighborhood level approaches seem to be of importance.
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25
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Everhov ÅH, Khalili H, Askling J, Myrelid P, Ludvigsson JF, Halfvarson J, Nordenvall C, Neovius M, Söderling J, Olén O. Work Loss Before and After Diagnosis of Crohn's Disease. Inflamm Bowel Dis 2019; 25:1237-1247. [PMID: 30551185 DOI: 10.1093/ibd/izy382] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND The aim of this study was to examine work loss in patients with Crohn's disease. METHODS Using nationwide registers, we identified incident patients with Crohn's disease (2007-2010) and population comparator subjects without inflammatory bowel disease, matched by age, sex, calendar year, health care region, and education level. We assessed the number of lost workdays due to sick leave and disability pension from 5 years before to 5 years after first diagnosis of Crohn's disease or end of follow-up (September 30, 2015). RESULTS Among the 2015 incident Crohn's disease patients (median age, 35 years; 50% women), both the proportion with work loss and the mean annual number of lost workdays were larger 5 years before diagnosis (25%; mean, 45 days) than in the 10,067 comparators (17%; mean, 29 days). Increased work loss was seen during the year of diagnosis, after which it declined to levels similar to before diagnosis. Of all patients, 75% had no work loss 24-12 months before diagnosis. Of them, 84% had full work ability also 12-24 months after diagnosis. In patients with total work loss (8.3% of all) before diagnosis, 83% did not work after. Among those with full work ability before diagnosis, the absolute risk of having total work loss after diagnosis was 1.4% (0.43% in the comparators). Our results were consistent across several sensitivity analyses using alternative definitions for date of diagnosis. CONCLUSIONS Patients with Crohn's disease had increased work loss several years before diagnosis, possibly explained by comorbidity or by diagnostic delay.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Masschusetts
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pär Myrelid
- Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University, Linköping, Sweden.,Department of Surgery, County Council of Östergötland Linköping, Linköping, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
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26
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Torres J, Ellul P, Langhorst J, Mikocka-Walus A, Barreiro-de Acosta M, Basnayake C, Ding NJS, Gilardi D, Katsanos K, Moser G, Opheim R, Palmela C, Pellino G, Van der Marel S, Vavricka SR. European Crohn's and Colitis Organisation Topical Review on Complementary Medicine and Psychotherapy in Inflammatory Bowel Disease. J Crohns Colitis 2019; 13:673-685e. [PMID: 30820529 DOI: 10.1093/ecco-jcc/jjz051] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/26/2019] [Indexed: 12/11/2022]
Abstract
Patients with inflammatory bowel disease [IBD] increasingly use alternative and complementary therapies, for which appropriate evidence is often lacking. It is estimated that up to half of all patients with IBD use various forms of complementary and alternative medicine during some point in their disease course. Considering the frequent use of such therapies, it is crucial that physicians and patients are informed about their efficacy and safety in order to provide guidance and evidence-based advice. Additionally, increasing evidence suggests that some psychotherapies and mind-body interventions may be beneficial in the management of IBD, but their best use remains a matter of research. Herein, we provide a comprehensive review of some of the most commonly used complementary, alternative and psychotherapy interventions in IBD.
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Affiliation(s)
- Joana Torres
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Pierre Ellul
- Department of Medicine, Division of Gastroenterology, Mater Dei Hospital, Msida, Malta
| | - Jost Langhorst
- Department of Internal Medicine and Integrative Gastroenterology, Kliniken Essen-Mitte and Chair for Integrative Medicine and Translational Gastroenterology, Klinikum Bamberg, University Duisburg-Essen, Germany
| | | | - Manuel Barreiro-de Acosta
- Department of Gastroenterology, IBD Unit, University Hospital Santiago De Compostela (CHUS), Santiago De Compostela, Spain
| | - Chamara Basnayake
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, Melbourne, Australia
| | - Nik John Sheng Ding
- Department of Gastroenterology, St. Vincent's Hospital Melbourne, Fitzroy, Melbourne, Australia
| | - Daniela Gilardi
- IBD Centre, Department of Gastroenterology, Humanitas Clinical and Research Institute, Rozzano, Milan, Italy
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, Division of Internal Medicine, University and Medical School of Ioannina, Ioannina, Greece
| | - Gabriele Moser
- Department of Internal Medicine III, Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria
| | - Randi Opheim
- Department of Gastroenterology, Oslo University Hospital, and Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Carolina Palmela
- Department of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy
| | - Sander Van der Marel
- Department of Gastroenterology and Internal Medicine, Haaglanden Medisch Centrum, The Hague, The Netherlands
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Yarlas A, Maher SM, Bayliss MS, Lovley A, Cappelleri JC, DiBonaventura MD. Psychometric validation of the work productivity and activity impairment questionnaire in ulcerative colitis: results from a systematic literature review. J Patient Rep Outcomes 2018; 2:62. [PMID: 30547275 PMCID: PMC6292832 DOI: 10.1186/s41687-018-0088-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/30/2018] [Indexed: 12/15/2022] Open
Abstract
Patients with ulcerative colitis, a type of inflammatory bowel disease, report negative impacts of disease symptoms on work-related outcomes, including absenteeism and presenteeism. As a way to better understand the impact of this disease and its treatment on work-related outcomes, the current review examines the use of the Work Productivity and Activity Impairment Questionnaire (WPAI), a patient-reported outcomes measure of absenteeism, presenteeism, and impairment in other activities, in studies of patients with ulcerative colitis. This review assesses the measurement properties of the WPAI in this patient population: its reliability, construct validity, ability to detect change, and responsiveness to effective treatments. Relevant data were extracted from 13 sources (journal articles and conference posters) identified following a systematic review of the published and gray literature. The evidence supports the WPAI as having test-retest reliability (reproducibility) over time; convergent validity, as indicated by moderate correlations with measures of quality of life and moderate-to-strong correlations with measures of disease activity; known-groups validity, as indicated by differences in WPAI scores between patients with active and inactive disease; ability (sensitivity) to detect change, as indicated by substantial improvement in scores for patients who achieve remission, accompanied by substantial worsening of scores for patients who relapse; and, responsiveness to treatment, with improvements in scores following treatments that reduce disease activity. Limitations included a lack of available evidence from randomized-controlled trials that could speak more directly to the WPAI's responsiveness to treatment. In conclusion, we recommend the use of the WPAI for measuring work outcomes in both observational studies and interventional trials that include patients with ulcerative colitis.
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Affiliation(s)
- Aaron Yarlas
- Optum, 1301 Atwood Avenue, Suite 311N, Johnston, RI 02919 USA
| | | | | | - Andrew Lovley
- Optum, 1301 Atwood Avenue, Suite 311N, Johnston, RI 02919 USA
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28
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Everhov ÅH, Khalili H, Askling J, Myrelid P, Ludvigsson JF, Halfvarson J, Nordenvall C, Söderling J, Olén O, Neovius M. Sick Leave and Disability Pension in Prevalent Patients With Crohn's Disease. J Crohns Colitis 2018; 12:1418-1428. [PMID: 30165593 DOI: 10.1093/ecco-jcc/jjy123] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease may affect the ability to work and lead to permanent disability. We aimed to investigate work loss in prevalent patients. METHODS We identified patients with Crohn's disease and general population comparators matched by sex, birth year, healthcare region and education. We assessed days of sick leave and disability pension retrieved from the Swedish Social Insurance Agency and estimated the absolute and relative risk of receiving disability pension [minimum 25% work impairment]. RESULTS In 2014, the 20638 Crohn's disease patients [median age 44 years] had more than twice as many mean lost workdays [disability pension: 44; sick leave: 19] as the 102038 comparators [disability pension: 20; sick leave: 8], mean difference 35 days [95% confidence interval 33-37]. However, the majority had no lost workdays [68% of patients and 85% of comparators]. The proportion of patients receiving disability pension was 15% (6.5% in the comparators, risk ratio 2.34 [2.25-2.43]) and was higher in all subgroups, especially in female patients [28% vs 13% in the comparators], in those with ≤9 years of education [41% vs 23%] and in ages 60-64 years [46% vs 25%]. The relative risk of disability pension within the patient cohort [adjusted for age, sex, region and education] was higher in patients with complicated disease behaviour, extraintestinal manifestations, need of surgery or treatment with biologics. The differences between patients and comparators remained when comparing other calendar years [2006-2013]. CONCLUSION Work loss was found in approximately one-third of patients. The mean number of lost workdays was twice as high as in the comparators.
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Affiliation(s)
- Åsa H Everhov
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Pär Myrelid
- Division of Surgery, Department of Clinical and Experimental Medicine, Faulty of Health Sciences, Linköping University and Department of Surgery, County Council of Östergötland Linköping, Sweden
| | - Jonas F Ludvigsson
- Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden
| | - Jonas Halfvarson
- Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Caroline Nordenvall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ola Olén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatric gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Freckmann M, Seipp A, Laass MW, Koletzko S, Claßen M, Ballauff A, Peplies J, Timmer A. School-related experience and performance with inflammatory bowel disease: results from a cross-sectional survey in 675 children and their parents. BMJ Open Gastroenterol 2018; 5:e000236. [PMID: 30538821 PMCID: PMC6254744 DOI: 10.1136/bmjgast-2018-000236] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/20/2018] [Accepted: 09/27/2018] [Indexed: 01/18/2023] Open
Abstract
Objective We describe school performance and experience in children with inflammatory bowel disease (IBD) across Germany and Austria. Predictors of compromised performance and satisfaction were evaluated to identify subgroups of increased risk. Design This cross-sectional analysis was based on a postal survey in children aged 10-15 with Crohn's disease, ulcerative colitis or unclassified IBD and their families. Multivariate regression analysis was used to assess influential factors on parental satisfaction with school, attending advanced secondary education (ASE), having good marks and having to repeat a class. Satisfaction was assessed based on the Child Healthcare-Satisfaction, Utilisation and Needs instrument (possible range 1.00-5.00). Results Of 1367 families contacted, 675 participated in the study (49.4%). Sixty-eight participants (10.2%) had repeated a year, 312 (46.2%) attended ASE. The median school satisfaction score was 2.67 (IQR 2.00-3.33). High socioeconomic status (SES) and region within Germany were predictive for ASE (OR high SES 8.2, 95% CI 4.7 to 14.2). SES, female sex and region of residence predicted good marks. Grade retention was associated with an active disease course (OR 2.7, 95% CI 1.4 to 5.3) and prolonged periods off school due to IBD (OR 3.9, 95% CI 1.8 to 8.6). Conclusions A severe disease course impacted on the risk of grade retention, but not on type of school attended and school marks. Low satisfaction of parents of chronically ill children with the school situation underlines the need for a more interdisciplinary approach in health services and health services research in young people.
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Affiliation(s)
- Magdalena Freckmann
- Division of Epidemiology and Biometry, Medical Faculty, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Alexander Seipp
- Division of Epidemiology and Biometry, Medical Faculty, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Martin W Laass
- Institute and Outpatient Clinics of Pediatric and Adolescent Medicine, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Sibylle Koletzko
- Dr. von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - Martin Claßen
- Childrens Hospital, Klinikum Links der Weser, Bremen, Germany
| | - Antje Ballauff
- Division of Pediatric Gastroenterology and Hepatology, Hospital Links der WeserCenter for Pediatrics and Adolescent Medicine, Krefeld, Germany
| | - Jenny Peplies
- Epidemiological Methods and Etiological Research, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Antje Timmer
- Division of Epidemiology and Biometry, Medical Faculty, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.,Epidemiological Methods and Etiological Research, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
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Lee S, Metcalfe A, Raman M, Leung Y, Aghajafari F, Letourneau N, Panaccione R, Kaplan GG, Seow CH. Pregnant Women with Inflammatory Bowel Disease Are at Increased Risk of Vitamin D Insufficiency: A Cross-Sectional Study. J Crohns Colitis 2018; 12:702-709. [PMID: 29546360 PMCID: PMC5972591 DOI: 10.1093/ecco-jcc/jjy030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Vitamin D insufficiency is prevalent in individuals with inflammatory bowel disease [IBD], as well as in pregnant women; however, the prevalence of vitamin D insufficiency in pregnant women with IBD is unknown. This study assessed the prevalence of vitamin D insufficiency in pregnant women with IBD and the adequacy of recommended supplementation. METHODS A cross-sectional study was conducted in pregnant women with inflammatory bowel disease [Crohn's disease = 61, ulcerative colitis = 41] and without inflammatory bowel disease [n = 574]. Chi square tests and log binomial regression were used to examine the prevalence of vitamin D insufficiency. Covariates included ethnicity and season. Adequacy of vitamin D supplementation during pregnancy was also assessed. RESULTS The prevalence of vitamin D insufficiency [25-OHD ≤75 nmol/L] in those with Crohn's disease was 50.8% (95% confidence interval [CI]: 38.4%-63.2%) and 60.9% [95% CI: 45.3%-74.7%] with ulcerative colitis compared with 17.4% [95% CI: 14.6%-20.8%] without inflammatory bowel disease. Women with inflammatory bowel disease were more likely to be vitamin D insufficient after adjusting for ethnicity and season (Crohn's disease-adjusted relative risk [aRR] = 2.98,;: 2.19-4.04; ulcerative colitis-aRR = 3.61; 95% CI: 2.65-4.93). Despite vitamin D supplementation, 32.3% [95% CI: 17.8%-51.2%] of those with Crohn's disease, 58.3% [95% CI: 37.1%-76.9%] of those with with ulcerative colitis, and 10.8% [95% CI: 6.9%-16.6%] of those without inflammatory bowel disease were still vitamin D insufficient. CONCLUSIONS Pregnant women with inflammatory bowel disease are at increased risk of vitamin D insufficiency compared with those without inflammatory bowel disease. The current guidelines for vitamin D supplementation may be inadequate for pregnant women with inflammatory bowel disease.
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Affiliation(s)
- Sangmin Lee
- University of Calgary Cumming School of Medicine, Community Health Sciences, Calgary, AB, Canada
| | - Amy Metcalfe
- University of Calgary Cumming School of Medicine, Calgary, AB, Canada,Obstetrics & Gynecology, Calgary, AB, Canada,Community Health Sciences, Medicine, Calgary, AB, Canada
| | - Maitreyi Raman
- University of Calgary Cumming School of Medicine, Medicine, Calgary, AB, Canada
| | - Yvette Leung
- University of British Columbia, Medicine, Vancouver, BC, Canada
| | - Fariba Aghajafari
- University of Calgary Cumming School of Medicine, Community Health Sciences, AB, Canada,Family Medicine, Calgary, AB, Canada
| | - Nicole Letourneau
- University of Calgary Cumming School of Medicine, Community Health Sciences, AB, Canada,University of Calgary Cumming School of Medicine, Medicine, AB, Canada,University of Calgary Cumming School of Medicine, Pediatrics & Psychiatry, AB, Canada,University of Calgary Faculty of Nursing, Nursing, Calgary, AB, Canada
| | - Remo Panaccione
- University of Calgary, Inflammatory Bowel Disease Clinic, Calgary, AB, Canada
| | - Gilaad G Kaplan
- University of Calgary, Division of Gastroenterology, Departments of Medicine, Calgary, AB, Canada
| | - Cynthia H Seow
- University of Calgary, Department of Medicine, Calgary, AB, Canada,Corresponding author: Dr Cynthia H. Seow, TRW building, Room 6D18, 3280 Hospital Drive NW, Calgary, AB, Canada, T2N 4Z6.
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Willian MK, D'Haens G, Yarlas A, Joshi AV. Changes in health-related quality of life and work-related outcomes for patients with mild-to-moderate ulcerative colitis receiving short-term and long-term treatment with multimatrix mesalamine: a prospective, open-label study. J Patient Rep Outcomes 2018; 2:22. [PMID: 30294708 PMCID: PMC6092727 DOI: 10.1186/s41687-018-0046-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 04/11/2018] [Indexed: 12/31/2022] Open
Abstract
Background Ulcerative colitis (UC) is associated with lower health-related quality of life (HRQoL), and with disease activity predicting lower HRQoL and worse work-related outcomes. The current study examined the burden of UC on patients' HRQoL, as well as changes in patients' HRQoL and work-related outcomes following short-term and long-term treatment with multimatrix mesalamine, and their correspondence with changes in disease activity. Methods Data were from an open-label, multinational, prospective trial (ClinicalTrials.gov identifier: NCT01124149) of 717 adults with active mild-to-moderate UC who were treated with 4.8 g/day multimatrix mesalamine tablets once daily for eight weeks (acute phase). Four-hundred sixty-one patients who achieved partial or complete clinical and endoscopic remission subsequently received treatment with daily 2.4 g/day multimatrix mesalamine for 12 months (maintenance phase). At baseline, Week 8, and Month 12, patients were administered patient-reported outcomes (PRO) measures of HRQoL (the SF-12v2® Health Survey [SF-12v2] and Short Inflammatory Bowel Disease Questionnaire) and work-related outcomes (Work Productivity and Activity Impairment questionnaire, UC-specific version). SF-12v2 scores were compared to the U.S. general population using Analysis of Variance models to assess burden of UC on HRQoL. Mixed-effects repeated-measures models compared PRO scores across visits to assess change in PRO scores over time. Correlations examined the correspondence of changes in PRO scores with changes on a modified UC disease activity index (UC-DAI). Results Baseline burden of disease observed on all SF-12v2 domains was partially eliminated at Week 8 and completely eliminated at Month 12. Statistically significant improvements from baseline were observed at both Week 8 and Month 12 for all PRO scores (all P < 0.001). Decreases in UC-DAI scores significantly predicted improvements in PRO scores during the acute treatment phase. Conclusions Patients with UC receiving daily multimatrix mesalamine treatment showed significant improvements in all measured domains of HRQoL and work-related outcomes. Patients who achieved partial or complete clinical and endoscopic remission maintained these improvements for most of these domains over 12 months with continued daily treatment. Changes in HRQoL and work-related outcomes were inversely related to changes in disease activity. Findings support the effectiveness of multimatrix mesalamine for improving, and sustaining improvements, in HRQoL and work-related outcomes.
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Affiliation(s)
| | - Geert D'Haens
- 2Inflammatory Bowel Disease Centre, Academic Medical Centre, University of Amsterdam the Netherlands, Meibergdreef, 91105 AZ Amsterdam, The Netherlands
| | - Aaron Yarlas
- 3Optum, 1301 Atwood Avenue, Suite 311N, Johnston, RI 02919 USA
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Shah A, Talley NJ, Walker M, Koloski N, Morrison M, Burger D, Andrews JM, McGuckin M, Jones M, Holtmann G. Is There a Link Between H. Pylori and the Epidemiology of Crohn's Disease? Dig Dis Sci 2017; 62:2472-2480. [PMID: 28281167 DOI: 10.1007/s10620-017-4496-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 02/08/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Case control studies suggest an inverse association between Helicobacter pylori (H. pylori) and Crohn's disease (CD). It is possible this could be accounted for by confounders such as antibiotic therapy. Analyzing the geographic distribution of H. pylori and the links with the incidence and prevalence of CD would be an alternative approach to circumvent these confounders. METHODS The literature was searched for studies published between 1990 and 2016 that reported incidence or prevalence data for CD in random population samples in developed countries (GDP per capita >20,000 USD/year). Corresponding prevalence studies for H. pylori in these same regions were then sought matched to the same time period (±6 years). The association between the incidence and prevalence of CD and H. pylori prevalence rates were assessed before and after adjusting for GDP and life expectancy. RESULTS A total of 19 CD prevalence and 22 CD incidence studies from 10 European countries, Japan, USA, and Australia with date-matched H. pylori prevalence data were identified. The mean H. pylori prevalence rate was 43.4% (range 15.5-85%), and the mean rates for incidence and prevalence for CD were 6.9 and 91.0/100,000 respectively. The incidence (r = -0.469, p < 0.03) and prevalence (r = -0.527, p = 0.02) of CD was inversely and significantly associated with prevalence of H. pylori infection. CONCLUSIONS Our data demonstrate a significant inverse association between geographic distribution of H. pylori and CD. Thus, it is highly unlikely that the findings of previous case control studies were simply due to confounding factors such as concomitant antibiotic use in CD patients.
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Affiliation(s)
- Ayesha Shah
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
| | - Nicholas J Talley
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Marjorie Walker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Natasha Koloski
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia.,Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Mark Morrison
- Microbial Biology and Metagenomics, Diamantina Institute, University of Queensland, Brisbane, QLD, Australia
| | - Daniel Burger
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia
| | - Jane M Andrews
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, University of Adelaide, Adelaide, SA, Australia
| | - Michael McGuckin
- Mater Medical Research Institute, Translational Research Institute, University of Queensland, Woolloongabba, QLD, Australia
| | - Mike Jones
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Gerald Holtmann
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Faculty of Medicine and Faculty of Health and Behavioural Sciences, Translational Research Institute, University of Queensland, Ipswich Road, Woolloongabba, Brisbane, QLD, Australia.
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Literature review: impacts of socioeconomic status on the risk of inflammatory bowel disease and its outcomes. Eur J Gastroenterol Hepatol 2017; 29:879-884. [PMID: 28471825 DOI: 10.1097/meg.0000000000000899] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The relationship between socioeconomic status (SES) and inflammatory bowel disease (IBD) is controversial. To date, research has focused on effects on incidence and prevalence, disease management and clinical outcomes; however, conclusions remain uncertain. This review examines current evidence, identifies what remains to be understood and explores the practical implications this has for today. A structured literature search in Ovid, Medline, the Cochrane library, Google Scholar and clinicaltrials.gov was performed using defined key words, including all articles up until 5 October 2016 assessing SES as a primary or secondary outcome measure. Twenty-one studies were identified, investigating incidence and prevalence (n=13), disease outcomes (n=5) and mortality (n=3). Data linking SES with IBD incidence are conflicting, with studies citing both positive and negative trends. Patients with low SES, particularly those with Crohn's disease, show higher rates of hospitalization, service usage and IBD-associated mortality. On the basis of the available study data, it is difficult to relate SES with the risk of IBD. For Crohn's disease, in particular, the link between deprivation and increased hospitalization and mortality observed from world-wide studies is alarming. It seems most likely that the cause links to well-documented behavioural, materialistic, psychosocial and life-course models used to explain social class inequalities in other diseases.
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Mahlich J, Matsuoka K, Nakamura Y, Sruamsiri R. The relationship between socio-demographic factors, health status, treatment type, and employment outcome in patients with inflammatory bowel disease in Japan. BMC Public Health 2017; 17:623. [PMID: 28676039 PMCID: PMC5496236 DOI: 10.1186/s12889-017-4516-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background Inflammatory Bowel Disease (IBD) constitutes a huge burden for patients and studies show that IBD patients have difficulties remaining in employment. Because there is no data about the unemployment of IBD patients in Japan. Methods We surveyed a representative sample of 1068 Japanese IBD patients regarding their employment status. Results We found that the labor force participation rate is lower and unemployment higher for patients with IBD compared to the general population. Factors associated with unemployment in the IBD sample are older age, female gender, and the prevalence of depression. Discussion IBD constitutes a high burden for patients in Japan regarding employment outcome.
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Affiliation(s)
- J Mahlich
- Health Economics, Janssen Pharmaceutical KK, 5-2, Nishi-kanda 3-chome Chiyoda-ku, Tokyo, 101-0065, Japan. .,Düsseldorf Institute for Competition Economics (DICE), University of Düsseldorf, Düsseldorf, Germany.
| | - K Matsuoka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Y Nakamura
- Health Economics, Janssen Pharmaceutical KK, Tokyo, Japan
| | - R Sruamsiri
- Health Economics, Janssen Pharmaceutical KK, 5-2, Nishi-kanda 3-chome Chiyoda-ku, Tokyo, 101-0065, Japan.,Center of Pharmaceutical Outcomes Research, Naresuan University, Phitsanulok, Thailand
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El-Matary W, Dufault B, Moroz SP, Schellenberg J, Bernstein CN. Education, Employment, Income, and Marital Status Among Adults Diagnosed With Inflammatory Bowel Diseases During Childhood or Adolescence. Clin Gastroenterol Hepatol 2017; 15:518-524. [PMID: 27717842 DOI: 10.1016/j.cgh.2016.09.146] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/18/2016] [Accepted: 09/06/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We aimed to assess levels of education attained, employment, and marital status of adults diagnosed with inflammatory bowel diseases (IBD) during childhood or adolescence, compared with healthy individuals in Canada. METHODS We performed a cross-sectional study of adults diagnosed with IBD in childhood or adolescence at Children's Hospital in Winnipeg, Manitoba from January 1978 through December 2007. Participants (n = 112) answered a semi-structured questionnaire on educational achievements, employment, and marital status. Patients were matched for age and sex with random healthy individuals from the 2012 Canadian Community Health Survey (controls, 5 per patient). Conditional binary logistic regression and random-effects ordinal logistic regression models were used for analysis. RESULTS Patients were followed for a mean duration of 14.3 years (range, 3.1-34.5 years). Persons with IBD were more likely to earn more money per annum and attain a post-secondary school degree or receive a diploma than controls (odds ratio, 1.72; 95% confidence interval, 1.13-2.60; P < .01 and odds ratio, 2.73; 95% confidence interval, 1.48-5.04; P < .01, respectively). There was no significant difference between patients and controls in employment or marital status. CONCLUSIONS Adults diagnosed with IBD during childhood seem to achieve higher education levels than individuals without IBD. This observation should provide reassurance to children with IBD and their parents. ClinicalTrials.gov number: NCT02152241.
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Affiliation(s)
- Wael El-Matary
- Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Canada; Department of Pediatrics, University of Alexandria, Egypt.
| | - Brenden Dufault
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Stan P Moroz
- Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Jeannine Schellenberg
- Department of Pediatrics, College of Medicine, University of Manitoba, Winnipeg, Canada
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Liu S, Ding J, Wang M, Wang G, Wu X, Feng M, Song P, Ren J, Guan W. Occupational risk for Crohn's disease: A two-center study. Dig Liver Dis 2016; 48:1318-1322. [PMID: 27553088 DOI: 10.1016/j.dld.2016.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/23/2016] [Accepted: 07/25/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Occupational factors have been suggested as possible elements in the etiology of Crohn's disease, although evidences have not been fully obtained. AIMS This study is to investigate possible associations between occupation and development of Crohn's disease. METHODS This prospective study was carried out in two major hospitals during January 2010 and December 2014. Demographic and clinical data were collected for the calculation of standard incidence ratios and 95% confidence intervals by occupation. RESULTS A total of 401 patients with Crohn's disease were recruited into this study. Participants were distributed into 8 major occupational groups, among which "professionists" (17.7%), "service and sales" (18.7%) and "unclassified individuals" (mainly students) (20.2%) took up the most proportions. Increased standard incidence ratios were found in "service and sales" (2.526±0.135, 95% CI: 1.939-3.290), "professionists" (4.216±0.142, 95% CI: 3.194-5.565), and most significantly, in "administrative staffs" (5.476±0.170, 95% CI: 3.926-7.639). In contrast, decreased standard incidence ratios for Crohn's disease were observed in the category of "workers in agriculture, forestry, animal husbandry, fishery and water conservancy" (0.088±0.146, 95% CIs: 0.066-0.117). CONCLUSION Occupational elements are implicated in the likelihood of development of Crohn's disease.
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Affiliation(s)
- Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jie Ding
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Meng Wang
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Gefei Wang
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Xiuwen Wu
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China
| | - Min Feng
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Peng Song
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Jianan Ren
- Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China.
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Raghu Subramanian C, Triadafilopoulos G. Care of inflammatory bowel disease patients in remission. Gastroenterol Rep (Oxf) 2016; 4:261-271. [PMID: 27899522 PMCID: PMC5193066 DOI: 10.1093/gastro/gow032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/21/2016] [Accepted: 09/04/2016] [Indexed: 12/11/2022] Open
Abstract
Inflammatory bowel disease (IBD) comprises two distinct conditions: ulcerative colitis and Crohn’s disease, both of which are chronic, relapsing disorders carrying significant morbidity, mortality and healthcare costs. With growing attention to coordinated healthcare for patients with chronic systemic diseases, this review focuses on the care of IBD patients in remission, their concerns, quality of life, follow-up, the role of primary care physicians and the IBD-specific aspects of long-term care. We did an extensive PubMed search for articles pertaining to IBD patients in remission and, along with the authors’ experience, formulated a comprehensive review. The difficulties faced by IBD patients in remission include but are not limited to education and employment concerns, psychosocial issues, problems related to health insurance, nutrition, fertility and infections. This review also addresses newer treatment modalities, the debatable effects of smoking on IBD and the importance of vaccination. IBD in remission can be a challenge due to its multifaceted nature; however, with a coordinated approach by gastroenterologists and other involved practitioners, several of these issues can be addressed.
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Restall GJ, Simms AM, Walker JR, Graff LA, Sexton KA, Rogala L, Miller N, Haviva C, Targownik LE, Bernstein CN. Understanding Work Experiences of People with Inflammatory Bowel Disease. Inflamm Bowel Dis 2016; 22:1688-97. [PMID: 27271487 DOI: 10.1097/mib.0000000000000826] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND People with inflammatory bowel disease (IBD) are at increased risk for unemployment and work absenteeism over the course of their adult lives. However, little is known about the firsthand experiences of people living with the disease regarding perceived barriers, facilitators, and strategies for navigating work roles. METHODS In this qualitative study, participants were purposefully recruited from 2 existing IBD cohort study samples. Recruitment strategies aimed for diversity in age, sex, and disease type, duration, and symptom activity. In-depth interviews sought perspectives of living with IBD. Data were analyzed using inductive qualitative methods. RESULTS Forty-five people currently or previously in the workforce participated; 51% were female. The mean age was 45.4 years (SD = 16.1; range = 21-73 years). Mean IBD duration was 10.9 years (SD = 6.3). Participants had a broad range of experiences in adapting to work roles. IBD symptoms and treatments interacted with other personal and environmental factors to shape the experiences of work. Experiences were shaped by: (1) personal health and well-being, (2) personal values, beliefs, and knowledge, (3) job characteristics, (4) workplace physical environment, (5) workplace culture, and (6) financial factors. Participants identified personal strategies and environmental supports that assisted them to navigate their work roles. CONCLUSIONS The perspectives of people with IBD provided in-depth understanding of contextual factors that influence work roles. They identified personal strategies to manage health and choices about work, environmental supports that promote timely workplace accommodations, and appropriate social insurance benefits as facilitators of work retention for people with IBD.
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Affiliation(s)
- Gayle J Restall
- *IBD Clinical and Research Centre, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; †Department of Occupational Therapy, Faculty of Health Sciences, College of Rehabilitation Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Departments of ‡Clinical Health Psychology, and §Internal Medicine, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; and ‖Department of Psychology, Faculty of Arts, University of Manitoba, Winnipeg, Manitoba, Canada
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Childhood Maltreatment Is Associated with Ulcerative Colitis but Not Crohn's Disease: Findings from a Population-based Study. Inflamm Bowel Dis 2015; 21:2640-8. [PMID: 26230860 DOI: 10.1097/mib.0000000000000551] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Previous research suggests a link between childhood adversities and inflammatory bowel disease (IBD); however, study limitations prevent generalization of findings. To address this, the current study uses a Canadian population-based sample to investigate the relationship between 3 childhood adversities and 2 types of IBD while controlling for a range of factors. METHODS Secondary data analysis of a subsample of the nationally representative 2012 Canadian Community Health Survey-Mental Health consisted of those with no missing data on any of the variables of interest (n = 21,852). The survey response rate was 68.9%. This study used logistic regression to estimate odds ratios of 3 types of childhood adversities (physical abuse, sexual abuse, and witnessing parental domestic violence) separately for ulcerative colitis and Crohn's disease, each compared with those without IBD. The final model controls for sociodemographics, health behaviors, and mental health. The exposure was assessed by retrospective self-report, and the outcome was by self-report of a health professional diagnosis. RESULTS In a fully adjusted model, those who are physically (odds ratio = 2.28; confidence interval, 1.39-3.75) or sexually abused (odds ratio = 2.64; confidence interval, 1.61-4.33) during childhood had significantly higher odds of ulcerative colitis than their non-maltreated peers. No relationship is found between witnessing parental domestic violence and ulcerative colitis. None of the early adversities are significantly related to Crohn's disease. CONCLUSIONS Childhood physical and sexual abuse are related to ulcerative colitis, but not Crohn's disease. Future research that can address epigenetic and neuroendocrine factors should investigate pathways through which early adversities may translate into one type of IBD but not another.
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Robust Association Between Inflammatory Bowel Disease and Generalized Anxiety Disorder: Findings from a Nationally Representative Canadian Study. Inflamm Bowel Dis 2015. [PMID: 26218145 DOI: 10.1097/mib.0000000000000518] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the link between inflammatory bowel diseases (IBD) and depression is well accepted, less is known about the relationship between IBD and anxiety disorders and factors associated with anxiety among those with IBD. METHODS Data were derived from the nationally representative 2012 Canadian Community Health Survey-Mental Health. The survey response rate was 68.9%. Two sets of analyses were undertaken. First, a series of logistic regression analyses were used to estimate the odd ratios of generalized anxiety disorder among those with IBD compared with those without (n = 22,522). The fully adjusted model controlled for sociodemographics, depression, substance abuse/dependence, pain, and adverse childhood experiences. Second, among those with IBD (n = 269), significant correlates of generalized anxiety disorder were identified using logistic regression. The presence of generalized anxiety disorder was determined using the WHO-CIDI lifetime criteria, and IBD was assessed by a self-reported health professional diagnosis. RESULTS Individuals with IBD had over twice the odds of anxiety compared with those without IBD, even when controlling for a range of potential explanatory factors (odds ratio = 2.18; 95% confidence interval, 1.50-3.16). Controlling for chronic pain and childhood adversities attenuate the relationship the most. Among those with IBD, a history of childhood sexual abuse, female gender, and chronic pain are the strongest correlates of anxiety. Those with Crohn's and ulcerative colitis were equally vulnerable to generalized anxiety disorder. CONCLUSIONS Our findings show that IBD is robustly related to generalized anxiety disorder. Health care professionals should be aware of the increased prevalence of generalized anxiety disorder among their patients with IBD, particularly women, those in chronic pain, and those with a history of childhood sexual abuse.
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Low Risk of Unemployment, Sick Leave, and Work Disability Among Patients with Inflammatory Bowel Disease: A 7-year Follow-up Study of a Danish Inception Cohort. Inflamm Bowel Dis 2015; 21:2296-303. [PMID: 26164663 DOI: 10.1097/mib.0000000000000493] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To assess the occurrence and risk of unemployment (UE), sick leave (SL), and work disability (WD) in incident patients with inflammatory bowel disease (IBD) after 7 years of follow-up compared with the background population and to determine outcome predictors. METHODS The study population consisted of patients aged 18 to 67 years (N = 379) from an IBD inception cohort registered January 1, 2003 to December 31, 2004 in the Copenhagen area. Clinical data were retrospectively collected from medical records. Data on UE, SL, and WD were retrieved from national registries. A random subset of the general population (n = 1435) were matched with IBD cases based on sex, age, and residency. The cumulative probabilities of UE, SL, and WD were calculated. A Cox proportional hazard regression was performed to identify possible outcome predictors. RESULTS There was no difference in UE rates between patients with IBD and controls (P = 0.23). The risk of SL was significantly increased in patients with IBD (hazard ratio 2.0; 95% confidence interval 1.7-2.4). Patients with IBD showed a higher risk of WD (hazard ratio 2.1; 95% confidence interval 1.2-3.8), particularly male patients older than 55 years. The rate of WD in CD (5.8%) was markedly lowered compared with previous studies. Within the IBD population, sex, educational level, disease behavior, smoking status, and surgery were predictors of UE, SL, and WD. CONCLUSIONS The observed increased risk of SL and WD in patients with IBD underscores the need for the early identification of risk factors. A multidisciplinary approach to secure IBD patients' participation in the labor market is recommended.
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Li G, Ren J, Wang G, Gu G, Ren H, Chen J, Wu Q, Wu X, Anjum N, Guo K, Li R, Li Y, Liu S, Hong Z, Li J. Impact of Crohn's Disease on Marital Quality of Life: A Preliminary Cross-Sectional Study. J Crohns Colitis 2015; 9:873-80. [PMID: 26142464 DOI: 10.1093/ecco-jcc/jjv121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 06/30/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Quality of marriage exerts a great effect on quality of life [QOL] and health outcomes. Few data are available on the effects of Crohn's disease [CD] on quality of marriage. We aimed to clarify whether and how CD affected the marital relationship. METHODS Web-based questionnaires were created including an ENRICH marital inventory, a general QOL survey [SF12], a short Inflammatory Bowel Disease Questionnaire [SIBDQ] and a modified Harvey-Bradshaw Index [HBI]. Married patients were enrolled through the outpatient registration system and diverse social media websites. Controls were subsequently enrolled and matched with the ratio of 1:1 through invitation emails and internet advertising. RESULTS A total of 243 patients completed valid questionnaires and then 243 matched individuals were enrolled. Male patients were more affected, representing a significantly reduced total marital score. CD impaired the dimensions of idealistic distortion and marital satisfaction in both genders. There were correlations between quality of marriage, SF12, SIBDQ and HBI. Mental scale of SF12 correlated best with the marital relationship, indicating more significant involvement of mental adjustment. Multiple linear regression demonstrated that spouse's educational background, duration of marriage from disease onset, enteral nutrition, hospitalisation in past 12 months, and number of previous hospitalisations, independently impacted on quality of marriage. CONCLUSIONS Certain aspects of the marital relationship were impaired in CD patients, especially in male subjects. In addition to medication, mental interventions should be given attention to improve the marriage of CD patients. Despite some novel findings in this study, this research orientation deserves more attention.
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Affiliation(s)
- Guanwei Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jianan Ren
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Gefei Wang
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Guosheng Gu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Huajian Ren
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jun Chen
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Qin Wu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Xiuwen Wu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Nadeem Anjum
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Kun Guo
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Ranran Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Yuan Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Song Liu
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Zhiwu Hong
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, P.R. China
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Mechanisms of Quality of Life and Social Support in Inflammatory Bowel Disease. J Clin Psychol Med Settings 2015; 23:88-98. [DOI: 10.1007/s10880-015-9431-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Ramos A, Calvet X, Sicilia B, Vergara M, Figuerola A, Motos J, Sastre A, Villoria A, Gomollón F. IBD-related work disability in the community: Prevalence, severity and predictive factors. A cross-sectional study. United European Gastroenterol J 2015; 3:335-42. [PMID: 26279841 DOI: 10.1177/2050640615577532] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/21/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS Data on the prevalence of work disability in patients with inflammatory bowel disease (IBD) are heterogeneous. As most studies have been performed in selected, often severe, IBD patients, the true prevalence of disability in the community remains controversial. The aim of this cross-sectional study was to evaluate the prevalence and severity of disability and its predictive factors in a community-based IBD population. PATIENTS AND METHODS Patients recorded in the community-based IBD register at the Hospital Universitario de Burgos were contacted. After informed consent they completed a set of questionnaires including demographic, clinical, disability and quality of life data. The statistical study was performed using SPSS 21. RESULTS A total of 293 patients were included - 151 Crohn's disease (CD), 142 ulcerative colitis (UC), 137 female, mean age: 45 ± 11 years, mean time since diagnosis: 10.6 ± 11 years. Twelve patients (4.1%) had a work-disability pension. In addition, 93 (32%) of all patients had an officially recognized disability degree, which was generally moderate (n = 73, 25%) or severe (N = 16, 5%). Age, time since IBD diagnosis, CD, perianal disease, incontinence, active disease, the need for anti-TNF or psychological treatment, previous surgeries and the number of diagnostic tests and medical visits in the previous year were predictors of disability. Major predictors of qualifying for a disability pension were age, IBD activity, incontinence, need for biological drugs and ostomy. CONCLUSION Mild to moderate work disability is frequent in IBD. However, only a minority of patients develop severe disability qualifying them for a pension.
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Affiliation(s)
- Alexis Ramos
- Servicio de Aparato Digestivo, Complejo Asistencial de Burgos, Spain
| | - Xavier Calvet
- Servei Aparell Digestiu, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Spain ; CIBERehd, Instituto de Salud Carlos III, Spain
| | - Beatriz Sicilia
- Servicio de Aparato Digestivo, Complejo Asistencial de Burgos, Spain
| | - Mercedes Vergara
- Servei Aparell Digestiu, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Spain ; CIBERehd, Instituto de Salud Carlos III, Spain
| | - Ariadna Figuerola
- Servei Aparell Digestiu, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Spain ; CIBERehd, Instituto de Salud Carlos III, Spain
| | - Jaume Motos
- Fundació Universitària del Bages, Universitat Autònoma de Barcelona, Spain
| | - Adoración Sastre
- Servicio de Aparato Digestivo, Complejo Asistencial de Burgos, Spain
| | - Albert Villoria
- Servei Aparell Digestiu, Corporació Sanitària Universitària Parc Taulí, Sabadell, Spain ; Departament de Medicina, Universitat Autònoma de Barcelona, Spain ; CIBERehd, Instituto de Salud Carlos III, Spain
| | - Fernando Gomollón
- CIBERehd, Instituto de Salud Carlos III, Spain ; Servicio de Aparato Digestivo, Hospital Clínico Universitario de Zaragoza, Spain
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Singh H, Nugent Z, Brownell M, Targownik LE, Roos LL, Bernstein CN. Academic Performance among Children with Inflammatory Bowel Disease: A Population-Based Study. J Pediatr 2015; 166:1128-33. [PMID: 25598305 DOI: 10.1016/j.jpeds.2014.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/17/2014] [Accepted: 12/03/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To determine grade 12 academic performance for children with inflammatory bowel disease (IBD). STUDY DESIGN Children diagnosed with IBD at age<17 years identified from the population-based University of Manitoba IBD Epidemiology Database were matched by age-, sex-, and area of residence to 10 randomly selected controls. Grade 12 educational outcomes (scores on the provincial grade 12 language arts and mathematics standards tests, and enrollment-in-grade-12-by- age-17) were determined by linkage to the province wide Manitoba Education Database. Linear and logistic regression analysis were used to compare the educational outcomes, adjusting for socioeconomic status and comorbidities and evaluate predictors of educational outcomes among children with IBD. RESULTS Grade 12 educational outcomes among 337 children with IBD were compared with 3093 without IBD. There were no significant differences among the 2 groups in the standardized scores (language arts: P=.31; mathematics: P=.48) or enrollment-in-grade-12-by- age-17 (P=.25). Lower socioeconomic status and diagnosis with mental health problems 6 months prior to and 6 months post-IBD diagnosis were independent predictors of worse educational outcomes. There was no significant effect of age of diagnosis of IBD, type of IBD (ulcerative colitis vs Crohn's disease), use of corticosteroids or immunomodulator agents, hospitalizations, or surgery for IBD. CONCLUSIONS Children with IBD on average achieve similar levels of academic achievement in grade 12 as those without IBD. This study underscores the educational impact of mental health conditions at IBD diagnosis among children.
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Affiliation(s)
- Harminder Singh
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Zoann Nugent
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Manitoba, Canada
| | - Marni Brownell
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura E Targownik
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Center for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Center, Winnipeg, Manitoba, Canada; Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Magalhães J, Castro FDD, Carvalho PB, Moreira MJ, Cotter J. Quality of life in patients with inflammatory bowel disease: importance of clinical, demographic and psychosocial factors. ARQUIVOS DE GASTROENTEROLOGIA 2015; 51:192-7. [PMID: 25296078 DOI: 10.1590/s0004-28032014000300005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022]
Abstract
CONTEXT Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. OBJECTIVES To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. METHODS Ninety two patients with Crohn's disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32) and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. RESULTS IBDQ-32 scores were significantly lower in female patients (P<0.001), patients with an individual perception of a lower co-workers support (P<0.001) and career fulfillment (P<0.001), patients requiring psychological support (P = 0.010) and pharmacological treatment for anxiety or depression (P = 0.002). A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001) and the perception of a lower co-workers support (P = 0.025) and career fulfillment (P = 0.001). CONCLUSIONS The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.
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Affiliation(s)
- Joana Magalhães
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - Francisca Dias de Castro
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - Pedro Boal Carvalho
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - Maria João Moreira
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
| | - José Cotter
- Gastrentroenterology Department, Centro Hospitalar do Alto Ave, E.P.E., Guimarães, Guimarães, Portugal
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Büsch K, da Silva SA, Holton M, Rabacow FM, Khalili H, Ludvigsson JF. Sick leave and disability pension in inflammatory bowel disease: a systematic review. J Crohns Colitis 2014; 8:1362-77. [PMID: 25001582 DOI: 10.1016/j.crohns.2014.06.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 05/16/2014] [Accepted: 06/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Inflammatory bowel disease has considerable effects on work-related outcomes and leads to high societal costs due to sick leave and disability pension. The aims of this study were to systematically review evidence on work-related outcomes that are relevant to productivity losses and to evaluate whether medical or surgical interventions have a positive impact on patients' work ability. METHODS A systematic literature search in PubMed was conducted in June 2013. Abstracts were screened by two independent reviewers, and full-text articles describing the frequency of work-related outcomes were retrieved. Two independent reviewers extracted data according to the PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses. Findings were organized by study design (non-interventional/interventional). Non-interventional studies were structured according to whether they presented data in comparison to control groups or not and interventional studies were summarized according to type of intervention. RESULTS This review included 30 non-interventional (15 with comparison groups and 15 without comparison group) and 17 interventional studies (9 surgical and 8 medical). The majority of the studies reported a high burden of work-related outcomes among inflammatory bowel disease patients regardless of the methodology used. While biologic agents showed positive effect on work absenteeism and presenteeism in randomized clinical trials, the impact of surgical interventions needs further evaluation. CONCLUSIONS Inflammatory bowel disease patients experience a high burden in work-related outcomes. Additional data on productivity losses and the long-term impact of interventions is needed to help inform decision-makers about treatment options and their benefits in reducing productivity losses in inflammatory bowel disease patients.
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Affiliation(s)
- Katharina Büsch
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Simone A da Silva
- Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Fabiana M Rabacow
- Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil
| | - Hamed Khalili
- Digestive Healthcare Center, Massachusetts General Hospital, Boston, MA, USA
| | - Jonas F Ludvigsson
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
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Low prevalence of disability among patients with inflammatory bowel diseases a decade after diagnosis. Clin Gastroenterol Hepatol 2014; 12:1330-7.e2. [PMID: 24361416 DOI: 10.1016/j.cgh.2013.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/06/2013] [Accepted: 12/06/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Disability is defined by chronic limitations that preclude the ability to engage in usual daily activities. Studies of disability in patients with inflammatory bowel disease (IBD) have focused on work and employment, with few descriptions of more general disability among multiple domains. We examined disability and the factors associated with it a decade after diagnosis in a population-based cohort of IBD patients. METHODS We interviewed 125 patients with Crohn's disease (CD) and 119 with ulcerative colitis (UC) from the population-based Manitoba IBD Cohort study a median of 12.3 years after diagnosis. Disability was assessed by using 2 validated measures. Disease activity was assessed semiannually, and long-term activity was defined as symptoms of active IBD at more than 65% of semiannual assessments. RESULTS Mean levels of disability were significantly higher among patients with CD than those with UC (P < .01). On the basis of the Work and Social Adjustment Scale, rates of disability were 19% among patients with CD vs 11% among those with UC (P < .05). Results from the World Health Organization Disability Assessment Schedule v.2 and the Work and Social Adjustment Scale correlated (r = 0.58 for patients with CD and 0.60 for those with UC; P < .01). Disability was associated with reduced quality of life. Long-term active disease and a lifetime history of major depression were associated with disability, whereas history of IBD-related surgeries or hospitalizations was not. CONCLUSIONS A minority of patients with IBD have significant disability after a decade of disease, although a higher proportion of patients with CD are disabled than those with UC. Long-term active disease and psychological factors are important predictors of disability. Depression should be treated as aggressively as the IBD itself.
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Sellin JH. Deconstructing disability in inflammatory bowel disease. Clin Gastroenterol Hepatol 2014; 12:1338-41. [PMID: 24614333 DOI: 10.1016/j.cgh.2014.02.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 02/27/2014] [Accepted: 02/27/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Joseph H Sellin
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
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50
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Szilagyi A, Leighton H, Burstein B, Xue X. Latitude, sunshine, and human lactase phenotype distributions may contribute to geographic patterns of modern disease: the inflammatory bowel disease model. Clin Epidemiol 2014; 6:183-98. [PMID: 24971037 PMCID: PMC4070862 DOI: 10.2147/clep.s59838] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Countries with high lactase nonpersistence (LNP) or low lactase persistence (LP) populations have lower rates of some "western" diseases, mimicking the effects of sunshine and latitude. Inflammatory bowel disease (IBD), ie, Crohn's disease and ulcerative colitis, is putatively also influenced by sunshine. Recent availability of worldwide IBD rates and lactase distributions allows more extensive comparisons. The aim of this study was to evaluate the extent to which modern day lactase distributions interact with latitude, sunshine exposure, and IBD rates. National IBD rates, national distributions of LP/LNP, and population-weighted average national annual ultraviolet B exposure were obtained, estimated, or calculated from the literature. Negative binomial analysis was used to assess the relationship between the three parameters and IBD rates. Analyses for 55 countries were grouped in three geographic domains, ie, global, Europe, and non-Europe. In Europe, both latitude and ultraviolet B exposure correlate well with LP/LNP and IBD. In non-Europe, latitude and ultraviolet B exposure correlate weakly with LP/LNP, but the latter retains a more robust correlation with IBD. In univariate analysis, latitude, ultraviolet B exposure, and LP/LNP all had significant relationships with IBD. Multivariate analysis showed that lactase distributions provided the best model of fit for IBD. The model of IBD reveals the evolutionary effects of the human lactase divide, and suggests that latitude, ultraviolet B exposure, and LP/LNP mimic each other because LP/LNP follows latitudinal directions toward the equator. However, on a large scale, lactase patterns also follow lateral polarity. The effects of LP/LNP in disease are likely to involve complex interactions.
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Affiliation(s)
- Andrew Szilagyi
- Division of Gastroenterology, Department of Medicine, Jewish General Hospital,
McGill University, Montreal, QC, Canada
| | - Henry Leighton
- Department of Atmospheric and Oceanic Sciences, McGill University, Montreal, QC,
Canada
| | - Barry Burstein
- Department of Medicine, Jewish General Hospital, McGill University, Montreal, QC,
Canada
| | - Xiaoqing Xue
- Department of Emergency Medicine, Jewish General Hospital, McGill University,
Montreal, QC, Canada
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