WORK DISABILITY AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE: PREVALENCE AND PREDICTIVE FACTORS IN A CROSS-SECTIONAL STUDY

Mtir Maha*, Kchir Hela, Mechergui Najla, Cherif Dhouha, Debbabi Habiba and Maamouri Nadia

ABSTRACT

Background: Inflammatory bowel disease (IBD) is a lifelong illness usually diagnosed in early adulthood. It is characterized by unpredictable flare-ups and debilitating symptoms that can interfere with the patient's ability to work and could lead to professional disintegration and job loss. The aim of this study was to estimate the prevalence of work disability among IBD patients and to identify its predictive factors. Methods: Cross-sectional study including IBD patients exercising a professional activity, followed at the Gastroenterology B department of the Rabta hospital in Tunisia, between April and December 2019. The work ability was assessed by the «Work Ability Index (WAI)» questionnairy. Results: We included 45 patients: 80% Crohn's disease (CD) and 20% ulcerative colitis (UC). The mean age was 44 years with a M/F sex ratio of 0.73. Work ability assessed by the WAI was perceived as poor in 38% of patients, leading to an overall average absence of 49.6 days/year (p=0.001). The work disability was more important in workers (p=0.008), employees in private sector (p=0.017), workers with atypical schedules (p=0.034) and in case of a professional seniority higher than 16.5 years (p=0.009). Patient-related factors were advanced age, low socio-economic conditions and low educational level. Disease-related factors were stricturing phenotype of CD, extensive UC, moderate to severe disease activity, presence of extra-intestinal manifestations (EIM) and corticotherapy. In multivariate analysis, osteoarticular EIM (OR=21.9 [95% CI: 2.302 - 208.356]; p=0.007) and moderate to severe disease activity (OR=34.2 [95% CI: 3.585 - 327.269]; p=0.002) were predictive factors of impaired work ability. Conclusion: According to our study, IBD would cause work disability in 38% of cases. Moderate to severe disease activity and the presence of rheumatological EIM were both identified as independent predictors of work disability. Thus, the WAI can be used as a screening tool to identify the need for rehabilitation.

Keywords: Inflammatory bowel disease, Work, Questionnaires, Absenteeism, Occupations, Ability.