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

Åsa H Everhov; Michael C Sachs; Jonas F Ludvigsson; Hamed Khalili; Johan Askling; Martin Neovius; Pär Myrelid; Jonas Halfvarson; Caroline Nordenvall; Jonas Söderling; Ola Olén; SWIBREG study group

doi:10.2147/CLEP.S244011

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

Clin Epidemiol. 2020 Mar 10:12:273-285. doi: 10.2147/CLEP.S244011. eCollection 2020.

Authors

Åsa H Everhov^{1

2}, Michael C Sachs², Jonas F Ludvigsson^{3

4}, Hamed Khalili^{2

5}, Johan Askling², Martin Neovius², Pär Myrelid^{6

7}, Jonas Halfvarson⁸, Caroline Nordenvall^{9

10}, Jonas Söderling², Ola Olén^{1

2

11}; SWIBREG study group

Affiliations

¹ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
² Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
³ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
⁴ Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden.
⁵ Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁶ Division of Surgery, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
⁷ Department of Surgery, County Council of Östergötland Linköping, Linköping, Sweden.
⁸ Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
⁹ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
¹⁰ Center for Digestive Disease, Division of Coloproctology, Karolinska University Hospital, Stockholm, Sweden.
¹¹ Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden.

Abstract

Purpose: 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: TNF inhibitor; aminosalicylate; disability pension; immunomodulator; inflammatory bowel disease; sick leave.

Grants and funding

This project was supported by grants from Karolinska Institutet (KI SÖS), Bengt Ihre Research Foundation, Bengt Ihre Research Fellowship, the Swedish Research Council, the Swedish Cancer Society, the Swedish Foundation for Strategic Research, and the Stockholm County Council (ALF). The project was also partly financed by an investigator-initiated grant to Karolinska Institutet and SWIBREG from Ferring. None of the funding organizations had any role in the design and conduct of the study; in the collection, management, and analysis of the data; or in the preparation, review, and approval of the manuscript.