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Indian Outpatients with Idiopathic Chronic Pancreatitis Have Catastrophic Healthcare Expenditure, Malnutrition, Anxiety/Depression and Work-Impairment

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Abstract

Introduction

There is paucity of data regarding economic burden, employment affection, psychological and nutritional status of CP patients, of non-alcoholic etiology, especially during their periods of stable disease, i.e., without any complications and/or recent endoscopic/surgical interventions.

Methods

In a prospective cohort study, conducted in outpatient clinic of a tertiary-care hospital, 66 consecutive adults with Idiopathic CP (± diabetes) and 152 matched (by age, socioeconomic status and monthly income) healthy controls were assessed for: (1) healthcare expenses in previous month by recall (catastrophic if > 40% of income); (2) nutritional status by anthropometry and food frequency questionnaire; (3) psychological status by Hospital Anxiety and Depression Scale (HADS); and (4) work-impairment by work productivity and activity impairment questionnaire: general health (WPAI-GH). CP patients were again reassessed for the above parameters after 6 and 12 month, respectively.

Results

Seventy-six percent CP patients (vis-à-vis 0% controls) had catastrophic healthcare expenditure. Forty-nine percent of CP patients(vis-à-vis 0% controls) met their healthcare expenses by either selling assets or obtaining loans at high-interest or from charitable donations. CP patients had lower BMI, were more likely to be malnourished and had a lower calorie intake vis-à-vis controls (median (IQR) recommended daily allowance (RDA): 71(19)% vs 97(23)%; [p < 0.0001]). Their median HADS Anxiety and depression scores were significantly higher than controls. Thirty-one (47%) CP patients were employed vis-a-vis 102 (67%) controls (p = 0.006); they had significantly higher work impairment. After one year, there was improvement in some of these above parameters in CP patients.

Conclusion

Idiopathic CP outpatients had catastrophic healthcare expenditure, malnutrition, abnormal psychological scores and work-impairment vis-à-vis healthy controls. Some of these parameters improved on follow-up.

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Abbreviations

CP:

Chronic pancreatitis

HRQOL:

Health-related quality-of-life

TPIAT:

Total pancreatectomy with Islet autotransplantation

PERT:

Pancreatic enzyme replacement therapy

OOP:

Out-of-pocket

BPL:

Below poverty line

HIV:

Human immunodeficiency virus

NAPS-2:

North American pancreatitis study-2

INR:

Indian rupee

US:

United States

SES:

Socioeconomic status

BMI:

Body-mass Index

WC:

Waist circumference

MUAC:

Mid upper-arm circumference

TSF:

Triceps skin-fold

BSF:

Biceps skin-fold

MAFA:

Mid-arm fat area

MAMA:

Mid-arm muscle area

RDA:

Recommended dietary allowance

ICMR:

Indian Council of Medical Research

HADS:

Hospital Anxiety and Depression Scale

WPAI-GH:

Work productivity and activity impairment questionnaire: general health

IQR:

Interquartile range

THE:

Total healthcare expenses

UHC:

Universal health coverage

SDGs:

Sustainable development goals

UN:

United Nations

USA:

United States of America

QOL:

Quality-of-life

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Acknowledgments

We would like to express our gratitude to the Department of Health and Family Welfare, Government of West Bengal, India for their support and encouragement and providing the infrastructure to carry out this study. We also like to express our gratitude to the West Bengal University of Health Sciences (WBHUS) for giving us the opportunity to pursue this study as a part of DM Thesis of PS. PS and KD had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. The study did not receive any external or internal funding. The authors have no Conflicts Of Interest to declare. The study received ethical clearance from the IPGME&R Research Oversight Committee vides Memo No. Inst/IEC/256 dated 13.02.2013.

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Authors and Affiliations

  1. Division of Gastroenterology, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India

    Pankaj Singh, Bidhan Chakraborty, Partha Sarathi Patra & Kshaunish Das

  2. Department of Psychiatry, Bangur Institute of Neurosciences, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India

    Sujit Sarkhel

  3. Division of Gastrointestinal Surgery, School of Digestive and Liver Disease, IPGME&R, 244 AJC Bose Road, Kolkata, 700020, India

    Sukanta Ray

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  1. Pankaj Singh
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  5. Partha Sarathi Patra
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  6. Kshaunish Das
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Contributions

PS Acquisition of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. BC Acquisition of data; critical revision of the manuscript for important intellectual content. SS Study supervision; critical revision of the manuscript for important intellectual content. SR Critical revision of the manuscript for important intellectual content. PSP Critical revision of the manuscript for important intellectual content. KD Study concept and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; administrative and technical support; study supervision.

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Correspondence to Kshaunish Das.

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Singh, P., Chakraborty, B., Sarkhel, S. et al. Indian Outpatients with Idiopathic Chronic Pancreatitis Have Catastrophic Healthcare Expenditure, Malnutrition, Anxiety/Depression and Work-Impairment. Dig Dis Sci 67, 3612–3622 (2022). https://doi.org/10.1007/s10620-021-07255-0

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