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Prevalence of-and risk factors for work disability in Dutch patients with inflammatory bowel disease

World Journal of Gastroenterology 2017年第46期23卷 8182-8192页

作者： Lieke M Spekhorst Bas Oldenburg Ad A van Bodegraven Dirk J de Jong Floris Imhann Andrea E van der Meulen-de Jong Marieke J Pierik Janneke C van der Woude gerard dijkstra Geert D'Haens Mark Lowenberg Rinse K Weersma Eleonora AM Festen 无 Department of Gastroenterology and Hepatology University of Groningen and University Medical Centre Groningen Department of Genetics University of Groningen and University Medical Centre Groningen Department of Gastroenterology and Hepatology University Medical Center Utrecht Department of Gastroenterology and Hepatology VU University Medical Center Department of Gastroenterology and Hepatology University Medical Center St. Radboud Department of Gastroenterology and Hepatology Leiden University Medical Center Department of Gastroenterology and Hepatology University Medical Center Maastricht Department of Gastroenterology and Hepatology Erasmus Medical Center Department of Gastroenterology and Hepatology Amsterdam Medical Center Parelsnoer Institute and the Dutch Initiative on Crohn and Colitis

AIM To determine the prevalence of work disability in inflammatory bowel disease(IBD), and to assess risk factors associated with work disability.METHODS For this retrospective cohort study, we retrieved clinical data from the Dutch IBD Biobank on July 2014, containing electronic patient records of 3388 IBD patients treated in the eight University Medical Centers in the Netherlands. Prevalence of work disability was assessed in 2794 IBD patients and compared with the general Dutch population. Multivariate analyses were performed for work disability(sick leave, partial and full disability) and long-term full work disability(> 80% work disability for > 2 years).RESULTS Prevalence of work disability was higher in Crohn's disease(CD)(29%) and ulcerative colitis(UC)(19%) patients compared to the general Dutch population(7%). In all IBD patients, female sex, a lower education level, and extra-intestinal manifestations, were associated with work disability. In CD patients, an age > 40 years at diagnosis, disease duration > 15 years,smoking, surgical interventions, and anti-TNFα use were associated with work disability. In UC patients, an age > 55 years, and immunomodulator use were associated with work disability. In CD patients, a lower education level(OR = 1.62, 95%CI: 1.02-2.58), and in UC patients, disease complications(OR = 3.39, 95%CI: 1.09-10.58) were associated with long-term full work disability.CONCLUSION The prevalence of work disability in IBD patients is higher than in the general Dutch population. Early assessment of risk factors for work disability is necessary, as work disability is substantial among IBD patients.

关键词： Inflammatory bowel disease Crohn’s disease Ulcerative colitis Work disability Health care costs

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Performance of the Montreal classification for inflammatory bowel diseases

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World Journal of Gastroenterology 2014年第41期20卷 15374-15381页

作者： Lieke M Spekhorst Marijn C Visschedijk Rudi Alberts Eleonora A Festen Egbert-Jan van der Wouden gerard dijkstra Rinse K Weersma Department of Gastroenterology and Hepatology University of Groningen and University Medical Centre Groningen Department of Genetics University of Groningen and University Medical Centre Groningen Department of Gastroenterology Isala Clinics Zwolle

AIM:To validate the Montreal classification system for Crohn's disease(CD) and ulcerative colitis(UC) within the Netherlands.METHODS:A selection of 20 de-identified medical records with an appropriate representation of the inflammatory bowel disease(IBD) sub phenotypes were scored by 30 observers with different professions(gastroenterologist specialist in IBD,gastroenterologist in training and IBD-nurses) and experience level with IBD patient care.Patients were classified according to the Montreal classification.In addition,participants were asked to score extra-intestinal manifestations(EIM) and disease severity in CD based on their clinical judgment.The inter-observer agreement was calculated by percentages of correct answers(answers identical to the "expert evaluation") and Fleiss-kappa(k).Kappa cutoffs: 0.8 excellent.RESULTS:The inter-observer agreement was excellent for diagnosis(k = 0.96),perianal disease(k = 0.92) and disease location in CD(k = 0.82) and good for age of onset(k = 0.67),upper gastrointestinal disease(k = 0.62),disease behaviour in CD(k = 0.79) and disease extent in UC(k = 0.65).Disease severity in UC was scored poor(k = 0.23).The additional items resulted in a good inter-observer agreement for EIM(k = 0.68) and a moderate agreement for disease severity in CD(k = 0.44).Percentages of correct answers over all Montreal items give a good reflection of the inter-observer agreement(> 80%),except for disease severity(48%-74%).IBD-nurses were significantly worse in scoring upper gastrointestinal disease in CD compared to gastroenterologists(P = 0.008) and gastroenterologists in training(P = 0.040).Observers with less than 10 years of experience were significantly better at scoring UC severity than observers with 10-20 years(P = 0.003) and more than 20 years(P = 0.003) of experience with IBD patient care.Observers with 10-20 years of experience with IBD patient care were significantly better at scoring upper gastrointestinal disease in CD than observers

关键词： Crohn’s disease Ulcerative colitis Montreal classi

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