Differences in Work Disability by Race and Gender in Patients With Inflammatory Bowel Disease

Introduction: Inflammatory bowel disease (IBD) is characterized by chronic, relapsing periods of intestinal inflammation with an unpredicTable clinical course. IBD flares may impact patients’ quality of life (QOL), require frequent admissions, and contribute to missed work. Health and gender disparities have been shown to impact IBD's course. Crohn’s Disease (CD) and Ulcerative Colitis (UC) are associated with high rates of emergency room (ER) visits and admissions. This study focused on elucidating differences in work disability by race and gender in IBD patients. Methods: A cross-sectional study done at our tertiary referral center enrolled IBD patients on the day of their colonoscopy. Patients received surveys containing demographic, socioeconomic, quality of life, and work disability questionnaires. After scope completion, scores for endoscopic disease severity (EDS) were recorded. Statistics were analyzed using SPSS. A multiple logistic regression adjusted for sex, race, IBD diagnosis, clinical disease activity, and EDS when work missed due to health was evaluated. Via a retrospective approach, charts were reviewed for LTO: admissions, ER visits, steroid use, and surgeries one year post enrollment. Fisher's exact test was used to characterize data. Results: A total of 86 patients, (51% F, 49% M, 74%W, 26%NW, 54% CD, 46% UC) were included in the study. Females had significantly more steroid use events than males (p=0.015) but no differences in work productivity. However, differences in ER visits, admissions, and surgeries between genders one year following enrollment were not significant. In terms of race, we found no difference in long term outcomes between whites and non-whites. However, non-white patients had 4 times the odds of having work missed due to health compared to whites(4.4;1.1-17.5). In Crohn's patients, the extent of endoscopic disease severity did not correlate to activity impairment, but it did in UC. Crohn's patients were 10 times more likely to miss work due to health than those with UC (10;1.2-84.0). In CD patients, endoscopic disease severity, but not clinical disease, was associated with missed work. (Table) Conclusion: Understanding long term outcomes and health disparities is imperative for effective management of IBD patients. Our study suggests gender differences in long term outcomes of IBD, and race differences in missed work. However, additional studies are needed to further characterize the reasons and help improve patient's work and activity impairment. Table 1. - Logistic Regression Adjusted for Age, Sex, Race, IBD diagnosis, Clinical Disease Activity, and Endoscopic Disease Severity Variable No Work Absences due to Health >1 Work Absence due to Health OR (95% CI) Sex MaleFemale 35 (92.1)34 (82.9) 3 (7.9)7 (17.1) 2.4 (0.6-10.1) Race WhiteNon-White 50 (92.6)17 (73.9) 4 (7.4)6 (26.1) 4.4 (1.1-17.5)* Diagnosis CDUC 33 (78.6)37 (97.4) 9 (21.4)1 (2.6) 10.1 (1.2-84)* Age 41.8 ± 14.6 40.0 ± 14.4 1.0 (0.9-1.0) HBI 4.5 ± 4.3 7.0 ± 4.7 1.1 (1.0-1.3) SES-CD 5.9 ± 6.0 14.6 ± 5.7 1.2 (1.1-1.4)* N (%) or mean ± standard deviation*p< 0.05Abbreviations: OR, odds ratio; CD, Crohn’s disease; UC, Ulcerative Colitis; HBI, Harvey-Bradshaw Index; SES-CD, Simple Endoscopic Score for Crohn’s Disease