Unraveling the Socioeconomic Impacts of Inflammatory Bowel Disease Through a Patient’s Lens

Background: Crohn’s disease (CD) is a complex refractory diagnosis that has significant impact on quality of life, relationships and general well-being. In this report of a 32-year-old male with fistulizing CD, we explore in greater depth the sequence of events that culminated in his advanced disease presentation. Methods: A 32-year-old male with a past medical history of CD diagnosed 6 years prior presented to a county hospital with complaints of hematochezia, abdominal pain and perirectal abscesses and fistulas. Physical exam revealed approximately 13 peri-anal and gluteal fold abscesses, with two setons that were placed approximately 18 months ago. Sigmoidoscopy confirmed active fistulizing colitis. Despite his previous diagnosis, the patient was never able to begin infliximab therapy. Following a lengthy discussion, the patient provided the three most significant aspects that he believed contributed to his advanced disease state, including patchy erosions and ulceration in the descending colon and fistula opening in rectum. Results: When the patient was diagnosed at age 26, he never truly appreciated the gravity of his diagnosis, nor expected it to progress to such a severe state. He believed if he had received proper guidance on dietary and lifestyle modifications, medication compliance and when/where to ask for help he would be able to manage his disease effectively. Rather, the patient opted to endure. The patient’s chronic symptomatic disease state had put considerable financial strain on him. As he often required accommodations during periods of significant flares, he felt a significant amount of workplace discrimination. This patient was forced to change jobs several times, which further exacerbated his financial strain and unstable income. Safe Housing: The constant stress of obtaining suitable living arrangements on a regular basis, compounded by the need for frequent doctor’s visits often led to increased levels of stress and anxiety which had contributed significantly to his symptoms. Conclusions: Unfortunately these situations are prevalent at county hospitals in the United States. Many of the Medicaid beneficiaries struggle with barriers to medication access, with limited coverage for non-medical services resulting in fragmented care. This report underscores the synergistic impact that these factors and many more have on disease burden. Through expanding a care team’s effort with a comprehensive approach to each patient, while advocating for our patients to policymakers, we can achieve better patient outcomes.