C Difficile Infections Significantly Impact Patients' Work, Health-Related Quality of Life

Findings from a recent survey reveal that Clostridium difficile infections are associated with significantly worse health-related quality of life (HRQoL) as well as a substantial impact on work, socializing, and general daily activities compared with patients without the infection. The study was led by Kirstin H. Heinrich, MPH, of Pfizer.

“In addition to worsened HRQoL, currently treated doctor-diagnosed C difficile infection (C-CDI) respondents suffer diminished work productivity, with the rate of absenteeism 2.5 times higher than among those with no history of CDI,” the investigators wrote. “Taken in concert, our results may indicate that the impact of C difficile infection on HRQoL is different from other diarrheal diseases.”

Study investigators collected 2013-2016 data from the cross-sectional, internet-based National Health and Wellness Survey (NHWS), which surveyed adults from the United States, Europe, and China. Overall, a total of 352,780 respondents were included, with participants characterized as C-CDI (n = 299), doctor-diagnosed prior C difficile infection (P-CDI) (n = 2,111), or those that have never had a C difficile infection (NO-CDI) (n = 350,370). Each group was created based on self-reported C difficile infection status.

For assessing HRQoL, investigators used the 4-week recall 36-Item Short-Form Health Survey version 2 (SF-36v2) form, which comprises both mental and physical components. Additionally, the investigators evaluated participants’ ability to work and perform other daily activities by using the 7-day recall Work Productivity and Activity Impairment questionnaire, general health version (WPAI-GH), with higher values representing greater impairment.

In the analysis adjusted for age, sex, Charlson Comorbidity Index (CCI) scores, education, and geographic location, the investigators observed significantly lower HRQoL scores among patients characterized as C-CDI and P-CDI vs NO-CDI patients for the mental component (39.5 and 42.7 vs 45.7, respectively; P <.05), physical component (38.9 vs 40.9 vs 45.5, respectively; P <.05), and health utility (0.58 vs 0.64 vs 0.71, respectively; P <.05).

Patients in the C-CDI and P-CDI group also reported missing significantly more work compared with NO-CDI (20.8% vs 16.0% vs 8.4%, respectively; P <.05). Those in the C-CDI and P-CDI groups also reported having greater work impairment (43.1% vs 33.7% vs 22.2%; P <.05) and greater activity impairment (60.7% vs 49.0% vs 34.4%; P <.05) compared with NO-CDI patients.

The strict inclusion of self-reported data for assessing the outcomes on interest as well as the inclusion of mostly North American and European respondents represent the primary limitations of the analysis. Additionally, the self-reported nature of the data may have resulted in inaccuracies in the data.

“Its limitations notwithstanding, our study highlights the global humanistic burden of C difficile infection and raises important concerns regarding the degree to which C difficile infection is associated with HRQoL, work, and activity impairments,” the investigators concluded. “Understanding the precise extent of C difficile infection’s impact on its sufferers’ HRQoL and impairment to work is essential in order to quantify the indirect costs and benefits of treatment and prevention strategies for this potentially debilitating infection.”

The study, “Impaired Quality of Life, Work, and Activities Among Adults with Clostridium difficile Infection: A Multinational Survey,” was published in Digestive Diseases and Sciences.