EMAIL TO A COLLEAGUE COMMENT

 

Health-Risk Behaviors and Chronic Conditions in Adults with IBD


On February 6, 2018, the CDC published a report that found being a former smoker was more prevalent and having never smoked was less prevalent among adults with inflammatory bowel disease (IBD) than among adults without IBD. In addition, meeting neither aerobic nor muscle-strengthening physical activity guidelines, averaging under seven hours of sleep during a 24-hour period, and experiencing serious psychological distress were more prevalent among adults with IBD than among those without IBD, as were several chronic conditions, including cardiovascular disease, respiratory disease, cancer, arthritis, weak or failing kidneys, any liver condition, and ulcer.

 

IBD, which includes Crohn’s disease and ulcerative colitis, involves chronic inflammation of the gastrointestinal tract. In 2015, an estimated 3.1 million adults in the United States had ever received a diagnosis of IBD. IBD might require lifelong disease management, including a combination of prescription medications, surgery, and medical treatment in outpatient, inpatient, emergency department, or ambulatory care settings. The symptoms and complications of IBD are associated with substantially impaired health-related quality of life. The total direct and indirect costs from loss of earnings or productivity attributable to IBD in the United States were estimated in 2014 to be $14.6 to $31.6 billion. However, because this estimate was based on a lower prevalence of IBD than that presented in this report, and given the impact of inflation, the current costs might be substantially higher. Understanding the health-risk behaviors and prevalence of certain chronic conditions among adults with IBD could inform clinical practice and lead to better disease management.

 

The prevalence of IBD varied significantly by age, sex, race, education, marital status, employment, and other demographic characteristics. The prevalence of IBD did not differ significantly among groups defined by health insurance coverage type or region of residence. The age-specific prevalence of IBD was higher among adults between the ages of 45 and 64 and adults 65 years or older (both 1.7 percent) than among those between the ages of 18 and 24 (0.5 percent) or between the ages of 25 and 44 (1.0 percent) years. The prevalence of IBD was higher among women (1.5 percent) than among men (1.0 percent). The prevalence of IBD was higher among non-Hispanic white adults (1.4 percent) than among non-Hispanic black adults (0.6 percent) or other non-Hispanic adults (0.8 percent). The prevalence of IBD was higher among those with less than a high school education (1.6 percent) than among those with at least a bachelor’s degree (1.1 percent). The prevalence of IBD was higher among those who were divorced, separated, or widowed (2.3 percent) than among persons who were married or cohabitating (1.1 percent). The prevalence of IBD was higher among currently unemployed (1.6 percent) adults than their employed (1.1 percent) counterparts. The prevalence of IBD was higher among U.S.-born (1.3 percent) adults than non-U.S.-born (0.8 percent) adults. The prevalence of IBD was higher among adults living in small metropolitan statistical areas (MSAs) (1.4 percent) than among those living in large MSAs (1.1 percent).

 

The prevalence of IBD varied significantly by health-risk behaviors such as smoking, not getting enough sleep, and not getting enough exercise. No statistically significant difference was detected in the prevalence of binge drinking or body mass index. Being a former smoker was more prevalent among adults with IBD (26.0 percent) than among adults without IBD (21.0 percent) and having never smoked was less prevalent among adults with IBD (55.9 percent) than among those without IBD (63.5 percent). The role of smoking in the development of IBD is not fully understood. Smoking among persons with Crohn’s disease, however, has been found to be associated with disease development, progression, and inferior treatment outcomes. Smoking cessation, therefore, is particularly recommended among patients with diagnosed Crohn’s disease. Adults with IBD had higher prevalences than those without IBD of sleeping less than seven hours per day (38.2 percent versus 32.2 percent). The prevalence of meeting neither aerobic nor muscle-strengthening physical activity guidelines was higher among adults with IBD (50.4 percent versus 45.2 percent), which might be an indication of severity of symptoms. Although there is no current exercise recommendation to adults with IBD, mild exercise in those with mild or moderate symptoms might not worsen disease symptoms. Furthermore, exercise might help build muscle mass, bone density, and improve sleep quality. Its benefits outweigh the risks for almost everyone.

 

The prevalence of IBD varied significantly by chronic conditions such as serious psychological distress, cardiovascular disease, respiratory disease, cancer, arthritis, weak or failing kidneys, any liver condition, and ulcer. No statistically significant difference was detected in the prevalence of diabetes. The prevalence of experiencing serious psychological distress was reported twice as frequently by adults with IBD (7.4 percent) than by those without IBD (3.4 percent). Among the selected chronic conditions, with the exception of diabetes, all were significantly more prevalent among adults with IBD than among those without IBD. The prevalence of ulcer was nearly five times higher among adults with IBD (26.0 percent) than among those without IBD (5.5 percent). The presence of certain chronic conditions in addition to IBD might impair health-related quality of life among affected persons and further complicate disease progression and care management.

 

See the CDC Report

 

See also Medical Law Perspectives Report: Gut-Wrenching Pain: Liability Risks Related to Gastrointestinal Disorders

 

 

REPRINTS & PERMISSIONS COMMENT