Many people with Crohn’s and Ulcerative Colitis go to work sick at some point. That practice — showing up to work sick — is called ‘presenteeism’, and can lead to lesser work performance. A study in this month’s Inflammatory Bowel Disease tries to add up the economic costs of that problem.
The study gives us very detailed picture of how people with IBD work with illness, and lots of their findings will be unsurprising to anyone who shown up sick, called in sick, or been fired for being sick. In reviewing prior research, it points out that patients with IBD:
- are less likely to obtain graduate or professional degrees.
- experience longer and more frequent unemployment.
- average 7.2 missed days of work per year.
- cost the U.S. economy $3.6 billion in missed work — or $5,228 per person with IBD.
The authors’ own research — a survey of 469 patients — shows that people with IBD are no more likely to miss work than other people. However, more than 60% of patients with IBD reported going to work sick, compared to 27.3% of healthy controls. Using another survey, the authors calculated ‘impairment’ from being sick at work, and found a similar result: more than 60% of patients with IBD reported impairment, compared to 30% of controls.
The study also looked at the difference between patients who were actively sick and those in remission. For those who were sick, “46.6% experienced absenteeism, 94.8% presenteeism, and 98.9% activity impairment”; those in remission had 14.4% absenteeism, 54.7% presenteeism, and 62.7% activity impairment.
Among the work limitations identified by people with IBD, the most common were fatigue at 41.8% of patients, irritability at 12.2% of patients, and decreased motivation at 11.7%. For those who missed work, the most common reasons were doctor appointments at 39%), abdominal pain or cramping at 24.4%, and hospital/emergency department visits at 22.1%.
Of the patients in the study, only 34.3% said there were able to make work adjustments (like telecommuting) to avoid taking time off due to their IBD. When they did take time off, 37.1% patients reported feeling stressed or pressured. Only 4.3% felt their bosses or co-workers complained about their sick leave — which seems low!
Among the people with IBD, 26.2% felt the disease had hurt their career path, including promotions and pay bumps; 11.2% lost a job or had to quit a job because of the disease, and 14% reported being stuck in a job they didn’t like just for the benefits (that is, ‘job-lock’).
After all this, the authors calculated the total costs from patients with active disease coming to work sick:
We estimated that total indirect costs for active patients on average were $1133 per week, assuming an average hourly compensation of $31.93, a 40-hour work week [….] This equals 55.1% of the total weekly compensation. This was significantly more than patients in remission, whose total indirect cost was estimated to be 18% of the total weekly compensation or $370.13 per week for a full-time employee.
In fact, presenteeism accounted for more of the costs of the disease than absenteeism, in both active and remissive patients. Presenteeism was 33.8% of costs for active and 13.5% for remissive patients, while absenteeism was 21.3% and 4.5% respectively.
A caution: it is easy to read these numbers as if the authors are suggesting people with IBD are bad workers who cost their employers and the economy large amounts of money. That is not the case; the article is not blaming patients for the burden of their disease. And to judge by the questions posed by Crohnology.com members, there are plenty of us who worry about working sick; matter of fact, I am writing this while getting over a cold and generally feeling lousy (not to mention my latent IBD). Point being, nobody should feel ashamed about ‘presenteeism’, and that’s certainly not what the authors want from this study.
Instead, the study sees the costs of the disease as an incentive for better care and management of chronic conditions, especially for those people who work. They conclude with a series of recommendations — and this is important — none of which include replacing sick workers with healthy ones:
Our recommendations therefore are divided into care provider recommendations and employer recommendations. Care providers (e.g., physicians, nurses, social workers, dieticians) will need to proactively discuss and propose employment-related adjustments tailored to the individual. They need to encompass mental support, nutritional support, wellness (e.g., fitness, yoga, meditation), and elimination of unnecessary tests, procedures, and medical appointments. Employer recommendations include job-coaching, an in-depth discussion about career- and workplace-related support measures. Surveys have shown that employees with chronic conditions are more likely to be highly satisfied with their jobs if they had high self-efficacy in managing their disease, perceive workplace support, and had less work limitations. This would allow employers to make effective adjustments leading to a decrease of presenteeism.
The goal, then, is to stem these costs by making sure employees with IBD have the tools and time they need to manage their disease and do the best work possible. It seems a long way off, but we should be glad research like this is getting us started.
The study is Zand, et al. “Presenteeism in Inflammatory Bowel Diseases: A Hidden Problem With Significant Economic Impact”, Inflammatory Bowel Disease 21:7 (July 2015). A copy of the article was generously provided by a co-author.
Photo “I Do Work Hard!” used under a Creative Commons commercial-modifications license by Flickr User JulyYu.