Work Loss in Relation to Pharmacological and Surgical Treatment for Crohn’s Disease: A Population-Based Cohort Study

• Main Authors: Everhov ÅH, Sachs MC, Ludvigsson JF, Khalili H, Askling J, Neovius M, Myrelid P, Halfvarson J, Nordenvall C, Söderling J, Olén O
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-03-01
• Series: Clinical Epidemiology
• Subjects: inflammatory bowel disease; sick leave; disability pension; tnf inhibitor; aminosalicylate; immunomodulator
• Online Access: https://www.dovepress.com/work-loss-in-relation-to-pharmacological-and-surgical-treatment-for-cr-peer-reviewed-article-CLEP

Åsa H Everhov, 1, 2 Michael C Sachs, 2 Jonas F Ludvigsson, 3, 4 Hamed Khalili, 2, 5 Johan Askling, 2 Martin Neovius, 2 Pär Myrelid, 6, 7 Jonas Halfvarson, 8 Caroline Nordenvall, 9, 10 Jonas Söderling, 2 Ola Olén 1, 2, 11 on behalf of the SWIBREG study group 1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; 2Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; 3Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 4Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; 5Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; 6Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; 7Department of Surgery, County Council of Östergötland Linköping, Linköping, Sweden; 8Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 9Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 10Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden; 11Department of Pediatric Gastroenterology and Nutrition, Sachs’ Children and Youth Hospital, Stockholm, SwedenCorrespondence: Åsa H EverhovDepartment of Surgery, Stockholm South General Hospital, Stockholm SE 118 61, SwedenTel [phone]Email [e-mail]: Patients with Crohn’s disease have increased work loss. We aimed to describe changes in work ability in relation to pharmacological and surgical treatments.Patients and Methods: We linked data from the Swedish National Patient Register, The Swedish Quality Register for Inflammatory Bowel Disease SWIBREG, The Prescribed Drug Register, The Longitudinal Integrated Database for Health Insurance and Labour Market Studies, and the Social Insurance Database. We identified working-age (19– 59 years) patients with incident Crohn’s disease 2006– 2013 and population comparator subjects matched by sex, birth year, region, and education level. We assessed the number of lost workdays due to sick leave and disability pension before and after treatments.Results: Of 3956 patients (median age 34 years, 51% women), 39% were treated with aminosalicylates, 52% with immunomodulators, 22% with TNF inhibitors, and 18% with intestinal surgery during a median follow-up of 5.3 years. Most patients had no work loss during the study period (median=0 days). For all treatments, the mean number of lost workdays increased during the months before treatment initiation, peaked during the first month of treatment and decreased thereafter, and was heavily influenced by sociodemographic factors and amount of work loss before first Crohn’s disease diagnosis. The mean increase in work loss days compared to pre-therapeutic level was ∼ 3 days during the first month of treatment for all pharmacological therapies and 11 days for intestinal surgery. Three months after treatment initiation, 88% of patients treated surgically and 90– 92% of patients treated pharmacologically had the same amount of work loss as before treatment start. Median time to return to work was 2 months for all treatments.Conclusion: In this regular clinical setting, patients treated surgically had more lost workdays than patients treated pharmacologically, but return to work was similar between all treatments.Keywords: inflammatory bowel disease, sick leave, disability pension, TNF inhibitor, aminosalicylate, immunomodulator