The relationship between inflammatory bowel disease and socioeconomic variables

OBJECTIVES: Inflammatory bowel diseases (IBD) are chronic diseases associat ed with considerable morbidity. This morbidity may have an impact on the ab ility of patients to remain employed, on their marital status, and on their ability to complete a course of higher education. It has long been held th at IBD patients are of a higher socioeconomic status and more educated than the general population. Our aim was to determine the relationship between IBD and employment, income, disability, education, and marital status in tw o population-based data sets based in the province of Manitoba, Canada. METHODS: Two studies are reported here. In study A, we surveyed persons wit h IBD, using the population-based University of Manitoba IBD Database, crea ted in 1995-1996. We compared these IBD patients to the general population with respect to employment, education, and marital status using data from t he 1996 National Population Health Survey. LED patients were queried as to their socioeconomic status as of the time of diagnosis and also at the time of the survey (1995-1996). In study B, we used a database that linked heal th care and census variables to determine differences in employment, income , occupation, and marital status among individuals who met the administrati ve definition of IBD (created in forming the University of Manitoba IBD Dat abase, based on ICD-9-CM codes 555 for Crohn's disease and 556 for ulcerati ve colitis) compared with the rest of working-age population. RESULTS: In study A we found that, compared with the general population, pa tients with IBD were more likely to be unemployed. Crohn's disease appeared to affect employment more than ulcerative colitis. IBD patients, however, had a low rate of reporting themselves as disabled (1.3%). Among those marr ied when diagnosed with IBD, approximately 10% of men and up to 20% of wome n were no longer married 5 yr later. More patients with IBD were married in 1995 compared with the general population; however, more were also divorce d. Fewer patients with IBD achieved postsecondary education. In study B, we found that individuals with IBD were twice as likely to be out of the labo r force as were controls. Sedentary occupations were twice as likely to be associated with IBD. The income, education level, and marital status of IBD patients were not significantly different from those of controls. CONCLUSIONS: Individuals with IBD at some time in the course of their illne ss are more likely not to be working than are those in the general populati on. Based on employment status and job classification, as well as income an d education, IBD patients are not of a higher socioeconomic status as previ ously reported. IBD patients are at least as likely as the general populati on to be married.