title: Constipation severity is associated with productivity losses and healthcare utilization in patients with chronic constipation.
abstract: We sought to evaluate the association between constipation severity, productivity losses and healthcare utilization in a national sample of Italian patients with chronic non-organic constipation (CC).
  
  
  
  We enrolled 878 outpatients with CC. Clinical and demographic data were collected by physicians during clinical examinations. Patients completed a self-administered questionnaire (Patient Assessment of Constipation-Symptoms, PAC-SYM; Work Productivity and Activity Impairment; healthcare utilization, and Symptoms Checklist 90 Revised - Somatization Scale, SCL-90 R).
  
  
  
  Mean PAC-SYM score was 1.62 ± 0.69. Mean weekly sick time due to constipation was 2.7 ± 8.6 h and productivity losses due to presenteeism was 19.7% ± 22.3%. Adjusted productivity losses in patients with severe CC (PAC-SYM score 2.3-4.0) compared to patients with mild symptoms (PAC-SYM score 0.0-1.0) was Italian Purchase Power Parity US$ 6160. Constipation severity (PAC-SYM quintiles) was associated with higher healthcare utilization (RRPAC-SYM 4/01.84; p-value for linear trend <0.01). After adjustment for somatization scores, the association of constipation severity with productivity losses and healthcare utilization rates was attenuated yet statistically significant.
  
  
  
  We observed a graded increase in productivity losses and healthcare utilization with increasing constipation severity. Further studies should evaluate whether significant savings might be achieved with regimens aimed at reducing the constipation severity.
authors: Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milano, Italy ; 'Clinica del Lavoro Luigi Devoto', Fondazione IRCCS 'Ca' Granda - Ospedale Maggiore Policlinico, Milano, Italy.
authors: Luca
authors: L
authors: Neri
authors: Gastroenterology Unit, Fondazione IRCCS 'Ca' Granda - Ospedale Maggiore Policlinico', Milano, Italy.
authors: Guido
authors: G
authors: Basilisco
authors: Dipartimento di Medicina Interna e Specialità Mediche, Gastroenterologia A, Università Sapienza, Roma, Italy.
authors: Enrico
authors: E
authors: Corazziari
authors: Dipartimento di Medicina Clinica, Università Alma Mater Studiorum, Bologna, Italy.
authors: Vincenzo
authors: V
authors: Stanghellini
authors: Gastroenterology and Hepatology Section, Department of Clinical and Experimental Medicine, University of Perugia School of Medicine, Perugia, Italy.
authors: Gabrio
authors: G
authors: Bassotti
authors: Unità Operativa di Gastroenterologia Universitaria, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy.
authors: Massimo
authors: M
authors: Bellini
authors: DoxaPharma, Milan, Italy.
authors: Ilaria
authors: I
authors: Perelli
authors: Department of Clinical and Experimental Medicine, Federico II University Hospital School of Medicine, Naples, Italy.
authors: Rosario
authors: R
authors: Cuomo
keywords: Chronic constipation; cost-of-illness study; direct cost; functional constipation; healthcare utilization; indirect cost; irritable bowel syndrome; productivity loss