Nationwide Temporal Trends in Incidence of Hospitalization and Surgical Intestinal Resection in Pediatric Inflammatory Bowel Diseases in the United States from 1997 to 2009

Abstract Background Inflammatory bowel diseases (IBD) are a group of chronic disabling gastrointestinal disorders, consisting mainly of Crohn’s disease (CD) and ulcerative (UC). A substantial part of the burden of illness in these conditions relates to the functional impairment, particularly affecting the ability to work. The aims of this study were to determine the impact of IBD on the working life of patient and to identify factors associated with a decreased productivity at work in patients with IBD. Methods A cross-sectional study carried out at the Gastroenterology department of Sahloul University Hospital (CHU) over a period of 6 months. Patients with IBD (CD or UC) who present to the outpatient clinic or are hospitalized in the ward or day hospital were included. A questionnaire drawn up on the basis of qualitative studies on this subject is used to collect data on the professional career, the characteristics of the position held, difficulties encountered at work on a daily basis.The questionnaire will be accompanied by the “Work Productivity and Activity Impairment” (WPAI) work productivity score. Results Among the 82 patients included, 58 had Crohn disease (CD) and 24 had ulcerative colitis (UC). The sex ratio was 1.2 and the mean age of our patients was 33.5 ± 10.2 years. . The majority of UC patients had pancolic involvement (n = 18; 75%). Among the 58 patients followed for CD, 24 (41.4%) had anoperineallesions. Twenty-two patients (26.8%) had already undergone intestinal resection. Six patients (7.3%) were on prolonged sick leave. The majority of patients worked in the private sector (n = 68; 82.9%). Two patients (2.4%) had a fixed rate of work per night. No patient had a job requiring frequent travel. Sixty-two patients (75.6%) had a weekly hourly volume greater than 40 hours.In half of the cases, the discovery of the disease preceded the choice of a professional career; among the remaining patients, this choice was influenced by IBD in 4 cases (10, 5%). Sixteen patients (21.5%) had to skip work hours during the week preceding the interview. The average number of hours missed due to a specific IBD-related problem was 5 hours with extremes ranging from 3 to 10 hours per week. An overall decrease in productivity (BGP) greater than 50% was objectified in 16 patients (21%). The average rates of absenteeism, presenteeism and BGP were 10.49%, 71.25% and 74.14% respectively. The presence of anoperineallesions was the only variable associated with BGP (50% vs 13.3%; p = 0.044). Conclusion The impact of IBD on professional activity appears to be significant and requires special attention from both the gastroenterologists and the occupational physicians.

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National Estimates of Financial Hardship From Medical Bills and Cost-related Medication Nonadherence in Patients With Inflammatory Bowel Diseases in the United States

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa266 ◽

2020 ◽

Author(s):

Nghia H Nguyen ◽

Rohan Khera ◽

Parambir S Dulai ◽

Brigid S Boland ◽

Lucila Ohno-Machado ◽

...

Keyword(s):

United States ◽

Health Care ◽

Financial Distress ◽

The United States ◽

Financial Hardship ◽

Financial Toxicity ◽

Medication Nonadherence ◽

Bowel Diseases ◽

Inflammatory Bowel ◽

Medical Bills

Abstract Background Inflammatory bowel diseases (IBDs) are associated with substantial health care needs. We estimated the national burden and patterns of financial toxicity and its association with unplanned health care utilization in adults with IBD in the United States. Methods Using the National Health Interview survey (2015), we identified individuals with self-reported IBD and assessed national estimates of financial toxicity across domains of financial hardship due to medical bills, cost-related medication nonadherence (CRN) and adoption of cost-reducing strategies, personal and health-related financial distress (worry about expenses), and health care affordability. We also evaluated the association of financial toxicity with emergency department (ED) utilization. Results Of the estimated 3.1 million adults with IBD in the United States, 23% reported financial hardships due to medical bills, 16% of patients reported CRN, and 31% reported cost-reducing behaviors. Approximately 62% of patients reported personal and/or health-related financial distress, and 10% of patients deemed health care unaffordable. Prevalence of financial toxicity was substantial even in participants with higher education, with private insurance, and belonging to middle/high-income families, highlighting underinsurance. Inflammatory bowel disease was associated with 1.6 to 2.6 times higher odds of financial toxicity across domains compared with patients without IBD. Presence of any marker of financial toxicity was associated with higher ED utilization. Conclusions One in 4 adults with IBD experiences financial hardship due to medical bills, and 1 in 6 adults reports cost-related medication nonadherence. These financial determinates of health—especially underinsurance—have important implications in the context of value-based care.

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