Black Christopher J, Ng Cho-Ee, Goodoory Vivek C, Ford Alexander C
Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, United Kingdom; Leeds Institute of Medical Research at St. James's, University of Leeds, Leeds, United Kingdom.
Department of Gastroenterology, County Durham and Darlington National Health Service Foundation Trust, Durham, United Kingdom.
Clin Gastroenterol Hepatol. 2024 Feb;22(2):386-396.e10. doi: 10.1016/j.cgh.2023.02.016. Epub 2023 Feb 27.
BACKGROUND & AIMS: Current classification systems based on bowel habit fail to capture the multidimensional nature of irritable bowel syndrome (IBS). We previously derived and validated a classification system, using latent class analysis, incorporating factors beyond bowel habit. We applied this in another cohort of people with IBS to assess its ability to capture the impact of IBS on the individual, the health care system, and society.
We collected demographic, symptom, and psychological health data from adults in the community self-identifying as having IBS, and meeting Rome IV criteria. We applied our latent class analysis model to identify the 7 subgroups (clusters) described previously, based on overall gastrointestinal symptom severity and psychological burden. We assessed quality of life, health care costs (£1 = $1.20), employment status, annual income, work productivity, and ability to perform work duties in each cluster.
Of 1278 responders, 752 (58.8%) met Rome IV criteria. The 7-cluster model fit the data well. The patients in the 4 clusters with the highest psychological burden, and particularly those in cluster 6 with high overall gastrointestinal symptom severity and high psychological burden, showed lower educational levels, higher gastrointestinal symptom-specific anxiety, were more likely to have consulted a gastroenterologist, and used more drugs for IBS. IBS-related and generic quality of life were impaired significantly in these 4 clusters and significantly fewer individuals reported earning ≥£30,000 per year. Productivity and the ability to work, manage at home, engage in social and private leisure activities, and maintain close relationships all were impacted significantly, and IBS-related health care costs over the previous 12 months were highest in these 4 clusters. In those in cluster 6, costs were more than £1000 per person per year.
Our clusters identify groups of individuals with significant impairments in quality of life, earning potential, and ability to work and function socially, who are high utilizers of health care.
当前基于排便习惯的分类系统未能体现肠易激综合征（IBS）的多维度特性。我们之前运用潜在类别分析得出并验证了一个分类系统，该系统纳入了排便习惯以外的因素。我们将此应用于另一组IBS患者，以评估其反映IBS对个体、医疗保健系统及社会影响的能力。
我们收集了社区中自我认定患有IBS且符合罗马IV标准的成年人的人口统计学、症状及心理健康数据。我们应用潜在类别分析模型，根据总体胃肠道症状严重程度和心理负担，识别先前描述的7个亚组（聚类）。我们评估了每个聚类中的生活质量、医疗保健费用（1英镑 = 1.20美元）、就业状况、年收入、工作效率以及履行工作职责的能力。
在1278名应答者中，752名（58.8%）符合罗马IV标准。7聚类模型与数据拟合良好。心理负担最重的4个聚类中的患者，尤其是第6聚类中总体胃肠道症状严重程度高且心理负担重的患者，教育水平较低，胃肠道症状特异性焦虑更高，更有可能咨询胃肠病学家，且使用更多治疗IBS的药物。这四个聚类中的IBS相关及总体生活质量显著受损，报告年收入≥30,000英镑的个体明显减少。工作效率、工作能力、在家管理能力、参与社交和私人休闲活动的能力以及维持亲密关系均受到显著影响，且这4个聚类在过去12个月中的IBS相关医疗保健费用最高。在第6聚类中，每人每年的费用超过1000英镑。
我们的聚类识别出了生活质量、收入潜力、工作能力及社交功能严重受损且医疗保健利用率高的个体群体。
