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P234. High risk of leaving the workforce in US employees with ulcerative colitis

R.D. Cohen1, J. Rizzo2, M. Yang2, M. Skup2, D. Macaulay3, C. Behrer3, B. Fok3, P.M. Mulani2, J. Chao2, 1University of Chicago, Chicago, IL, United States, 2Abbott Laboratories, Abbott Park, IL, United States, 3Analysis Group, Inc., New York, NY, United States

Background

Ulcerative colitis (UC) can substantially impact quality of life and reduce work productivity [1,2]. We evaluated the risk of leaving the workforce for privately insured US employees with UC compared with demographically matched controls without UC.

Methods

Active employees ages ≥18 years with ≥2 UC diagnoses (dx) (ICD-9: 556.xx) between 1/1/1998–3/31/2010 were identified from OptumHealth Reporting and Insights database. Employees with Crohn's disease (CD, ICD-9: 555.xx) were excluded. Patients (pts) had continuous eligibility for ≥1 year before first UC dx (index date) and were followed until end of eligibility. Pts with UC were matched 1:1 on sex, age ±1 year, region, and company to controls (active employees without UC or CD). Index dates for controls were the same as the matched UC pt. Risk of leaving the workplace (short- and long-term disability, leave of absence, early retirement) was examined using Kaplan–Meier survival curves and log-rank tests. Analyses were performed for all pts and for those who developed moderate to severe UC defined by UC hospitalization or use of systemic corticosteroids, immunosuppressants, or biologics.

Results

3,889 employees with UC and 3,889 matched controls (mean age, 44.3 years; 65.5% male) met inclusion criteria and were followed for an average of 3.8 years. Regardless of UC severity, UC pts were more likely to experience short- and long-term disability, or take a leave of absence after the UC dx vs controls (table). Additionally, pts with moderate to severe UC (N = 1,917) more frequently experienced leaving the workplace than controls.

Table: Five-year and overall risk of experiencing work-lossa
OutcomesUC (all)Moderate to severe UC
 UC pts
(N = 3,889)
Controls
(N = 3,889)
UC pts
(N = 1,917)
Controls
(N = 1,917)
 5-YearOverall5-YearOverall5-YearOverall5-YearOverall
Short-term disabilityb0.180.260.120.180.220.320.130.20
Long-term disabilityb0.030.040.010.020.030.050.010.02
Leave of absenceb0.150.230.110.180.170.280.110.18
Early retirement0.100.190.090.180.110.200.100.18
Any eventb0.330.520.260.400.380.590.270.41
aEmployees who did not leave the workplace after the index date were censored at the end of their eligibility.
bP < 0.001 for patients with UC vs. controls from log-rank test comparing overall risk.

Conclusion

US employees with UC had a 30% increased risk of experiencing work-loss vs controls. Improving control of UC has the potential to allow UC pts to stay active in the workforce, likely increasing productivity and off-setting treatment costs.

1. Cohen RD, et al, (2010), Aliment Pharmacol Ther, 31:693–707.

2. Reinisch W, et al, (2007), Inflamm Bowel Dis. 2007;13:1135–40.