Work Impairment in Patients with Celiac Disease and Its Relationship with Persistence of Symptoms, Dietary Adherence, Quality of Life, and Psychological Morbidity

Background and Aims: Data on work absenteeism in celiac disease (CD) are scarce. This study aimed to evaluate the hours of work lost, reasons for work absenteeism, and their association with quality of life (QOL) and psychological morbidity in celiac patients on a gluten-free diet (GFD). Methods: Adult celiac patients on a GFD were enrolled in a cross-sectional Italian study between October-2022 and October-2024. The survey included the Work Productivity and Activity Impairment (WPAI:CD), the Celiac Disease-specific Quality of Life scale (CD-QOL), the Beck Depression Inventory scale (BDI), and the State-Trait Anxiety Inventory scale (STAI-Y). A multivariable analysis was conducted to identify factors independently associated with work absenteeism. Results: 167 patients (121F, mean age at diagnosis of CD 32 ± 13 years) were enrolled. 23/167 (13.8%) lost working hours in the previous 30 days (mean of 6.61 h missed at work at 30 days). Reasons behind work absenteeism included outpatient clinic attendance (55.4%), symptom persistence despite a GFD (30.4%), and issues with GFD adherence (14.3%). Over a 30-day span, absentees had more ongoing symptoms despite the GFD (95.7% vs 67.4%, p = 0.05), higher scores on depression (median BDI-II score 12 vs 6, p = 0.04), and lower QOL (median CD-QOL score 79.0 vs 85.5, p = 0.015) than those who did not lose working hours. At multivariable analysis, being on a GFD for < 1 year (p = 0.001), and persistent symptoms despite a GFD (p = 0.04) were strongly associated with work absenteeism at 30 days. Conclusions: CD can significantly impair work activities. Persistent symptoms and GFD < 1 year are strongly associated with work impairment. Clinicians should be aware of and manage these issues.