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Multicenter Study
. 2018 Nov;63(11):2864-2873.
doi: 10.1007/s10620-018-5222-1. Epub 2018 Aug 3.

Impaired Quality of Life, Work, and Activities Among Adults with Clostridium difficile Infection: A Multinational Survey

Kirstin Heinrich  1 , James Harnett  2 , Jeffrey Vietri  3 , Richard Chambers  3 , Holly Yu  3 , Marya Zilberberg  4   5
Affiliations
Multicenter Study

Impaired Quality of Life, Work, and Activities Among Adults with Clostridium difficile Infection: A Multinational Survey

Kirstin Heinrich et al. Dig Dis Sci. 2018 Nov.

Abstract

Background: Evidence of humanistic detriments of Clostridium difficile infection (CDI) remains limited.

Aims: To assess humanistic burden associated with CDI.

Methods: Self-reported National Health and Wellness Survey data between 2013 and 2016 were analyzed for the USA, five European countries, China, and Brazil. Outcome measures included SF-36v2® for health-related quality of life (HRQoL) and Work Productivity and Activity Impairment questionnaire. Respondents (≥ 18 years old) were classified as (1) currently treated doctor-diagnosed CDI (C-CDI), (2) doctor-diagnosed prior CDI (P-CDI), or (3) never experienced CDI (NO-CDI). Regression modeling assessed the association between CDI status and outcomes, adjusting for potential confounders.

Results: Of 352,780 respondents, 299, 2111, and 350,370 met the criteria for C-CDI, P-CDI, and NO-CDI, respectively, with 45% of the total from the USA. C-CDI and P-CDI respondents were older, were less often employed and had more comorbidities than those with NO-CDI. After adjustment for covariates, C-CDI and P-CDI had significantly lower HRQoL relative to NO-CDI for mental (MCS 39, 43 vs. 46) and physical (PCS 39, 41 vs. 46) component summary scores, and health utility (SF-6D 0.58, 0.64 vs. 0.71) (all p < 0.05), meeting common thresholds for minimally important differences. Those with C-CDI and P-CDI reported missing more work (21, 16 vs. 8%), greater impairment while working (43, 34 vs. 22%), and more activity impairment (61, 49 vs. 34%) than those with NO-CDI (all p < 0.05), respectively.

Conclusions: CDI is associated with meaningfully worse HRQoL and greater impairment to work and activities compared with NO-CDI. The impairment directly attributable to CDI requires further evaluation.

Keywords: Clostridium difficile; Outcomes; Quality of life; Questionnaire; Survey; Work productivity.

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Conflict of interest statement

HK, YH, VJ, CR, and HJ are employees and stockholders of Pfizer, Inc., the study sponsor. ZM has received compensation as a consultant to Pfizer, Inc., including for the development of this manuscript. She has also received research and/or consulting funding from Merck, The Medicines Company, Astellas, Melinta, Tetraphase, and Paratek. Editorial support was provided by Scott Vuocolo of Pfizer, Inc.

Figures

Fig. 1
Fig. 1
Sample diagram
Fig. 2
Fig. 2
Unadjusted SF-36v2® norm-based mean health domain scores by CDI status. *Statistically significant difference meeting MID criteria versus NO-CDI, tstatistically significant difference versus P-CDI, Δmeeting MID criteria versus P-CDI
Fig. 3
Fig. 3
Adjusted mean SF-36v2® summary scores by CDI status. * Statistically significant difference meeting MID criteria versus NO-CDI, t statistically significant difference meeting MID criteria versus P-CDI
Fig. 4
Fig. 4
Adjusted mean health utility by CDI status. * Statistically significant difference meeting MID criteria versus NO-CDI, t statistically significant difference meeting MID criteria versus P-CDI
Fig. 5
Fig. 5
Adjusted mean work and activity impairment by CDI status. * Statistically significant difference versus NO-CDI, differences between P-CDI and C-CDI were not statistically significant
See this image and copyright information in PMC

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