title: Determinants of health-related quality of life in Crohn's disease: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Understanding the determinants of Crohn's disease (CD) patients' health-related quality of life (HRQOL) may facilitate interventions that improve HRQOL. Therefore, we systematically assessed determinants of HRQOL in adult CD patients.
  
  
  METHODS
  The databases PubMed, EMBASE, the Cochrane Library, PsycINFO and CINAHL were searched for English abstracts, related to socio-demographic, psychological, clinical and treatment-related determinants of HRQOL in CD disease. Two independent reviewers extracted study characteristics and assessed the methodological quality according the criteria of Hayden et al. The main outcome was the number of studies showing a statistically significant association between the above-mentioned determinants and HRQOL. A meta-analysis was performed to quantify the relationship between disease activity and HRQOL.
  
  
  RESULTS
  Of the 2060 articles identified, 29 eligible studies were included. The majority of studies were cross-sectional and had a moderate to high quality. Data on psychological determinants were scarce. Work disability, increased disease activity, number of relapses, corticosteroid treatment and hospitalization rate were significantly associated with a lower HRQOL in the majority of included studies. Biological treatment positively influenced HRQOL. The pooled data on the association between disease activity and HRQOL resulted in a weighed mean correlation coefficient of -0.61 (CI -0.65 to -0.57).
  
  
  CONCLUSIONS
  HRQOL of adult CD patients is consistently determined by markers of active disease, including work disability, increased disease activity, number of relapses, biological treatment and hospitalization rate. As disease activity contributed to only 37% of HRQOL, there remains a need for additional, possibly modifiable, determinants. These determinants may refine possibilities to improve HRQOL.
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands. Electronic address: M.vanderhave@umcutrecht.nl.
authors.forename: Mike
authors.initials: M
authors.lastname: van der Have
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Karen S
authors.initials: KS
authors.lastname: van der Aalst
authors.affiliation: Section Medical Psychology, Leiden University Medical Center, The Netherlands.
authors.forename: Ad A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Max
authors.initials: M
authors.lastname: Leenders
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Siersema
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
authors.affiliation: Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.
authors.forename: Herma H
authors.initials: HH
authors.lastname: Fidder
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003424:Crohn Disease / Q000188:drug therapy / Q000523:psychology; D004651:Employment; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D011788:Quality of Life; D012008:Recurrence; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal
keywords: Crohn's disease; Determinants; Health-related quality of life; Patient-reported outcomes; Systematic review