Socio-economic impairment in patients with Crohn's disease as compared to their healthy siblings and friends

Background: Crohn's disease (CD) can cause social and occupational limitations leading to substantial productivity losses. The aim of the study was to compare the social and occupational situation of CD patients with that of their not affected siblings or friends of youth who grew up in a similar socio-economic environment.

Methods: One-hundred consecutive CD patients of a single referral centre were interviewed using standardized questionnaires (EQ-5D, SF-12) and general questions about partnership, domestic circumstances, education, and occupation. Disease activity was determined by the Harvey Bradshaw Index (HBI). Not affected siblings or friends of youth were included as control group (n=42). The primary endpoint was health-related quality of life assessed by EQ-5D.

Results: Fifty-two CD patients were females. Age at diagnosis was 27.9±9.4 years. Age at study entry was 43.9±10.4 years. Disease activity at study entry was: remission (HBI<5) in 62, mild disease (HBI 5–7) in 14, moderate disease (HBI 8–16) in 22, and severe disease (HBI>16) in 2 patients. Seven patients had an acute flare during the last 3 months. Seventy-one CD patients had undergone at least one intestinal CD-related surgery. Twenty-four (57%) of the controls were females. Age at study entry of the controls was 44.0±12.5 years. CD patients had a lower health-related quality of life compared to controls in EQ-5D (visual analog scale (VAS) 71.4±21.5 vs. 80.2±18.1, p=0.027) as well as in SF-12 (physical: 46.0±10.2 vs. 50.9±8.8, p=0.004; mental: 48.2±9.8 vs. 52.0±7.3, p=0.01). Among CD patients an impairment in the EQ-5D dimensions „usual activity“ (p=0.001) and „pain/discomfort“ (p=0.009) was found. Patients with active CD (HBI≥5; n=38) had lower values of EQ-5D VAS and SF-12 compared to CD in remission (EQ-5D: 56.5±19.1 vs. 80.5±17.5, p<0.001; SF-12 physical: 39.7±10.4 vs. 49.8±8.0, p<0.001; SF-12 mental: 41.8±10.7 vs. 52.1±6.7, p<0.001). No difference was found between patients in remission and controls. 15.4% of patients had a delay in education caused by CD, compared to 2.4% in controls caused by any other disease (p=0.04). CD patients tended to have taken early retirement more often (17% vs. 4.8%; p=0.051). No difference was found in level of education, partnership, and domestic circumstances.

Conclusion: Health-related quality of life is reduced among patients with active CD. CD patients achieve similar levels of education as their siblings and friends of youth, but the education is delayed due to the disease and they trend to take early retirement more often.