OBJECTIVES:

To assess the health-related quality of life (HRQoL), work and activity (WA) impairment associated with Clostridium difficile infection (CDI).

METHODS:

Data aggregated from the 2013-2016 US, 5EU, China and Brazil internet-based cross-sectional National Health and Wellness Surveys (NHWS) were used. NHWS includes the revised Medical Outcomes Study 36-item Short-Form and the Work Productivity and Activity Impairment General Health questionnaire. Respondents (≥18 years) were classified as 1) currently treated doctor-diagnosed CDI (CT), or 2) doctor-diagnosed CDI not currently treated (NT), or 3) never experienced CDI (NO), based on self-reports. Regression modeling assessed the association between CDI status and outcomes after adjusting for Charlson Comorbidity Index, education, age, sex, and country.

RESULTS:

Of 352,780 respondents, 299 and 2,111 met criteria for CT and NT, respectively. About 45% of respondents were US-based. CT and NT were older (mean 48, 53 vs. 46), more often unemployed (50%, 57% vs. 41%), and had higher mean CCI (2.61, 0.92 vs. 0.20) than NO. More females were NT (67%) than CT (49%) or NO (53%). After adjustment for covariates, CT and NT reported significantly lower mean HRQoL than NO: mental component summary score (39, 43 vs. 46), physical component summary score (39, 41 vs. 46), and health utility (0.58, 0.64 vs. 0.71) (all p<0.05). These differences met commonly accepted thresholds for minimal clinically important difference. CT and NT reported significantly greater percent of work time missed (21%, 16% vs. 8%), impairment while working (43%, 34% vs. 22%), overall work impairment (52%, 39% vs. 26%) and activity impairment (61%, 49% vs. 34%) due to health than NO (all p<0.05).

CONCLUSIONS:

CDI is associated with clinically meaningful and statistically significant lower HRQoL and statistically significant higher WA impairment compared to those with no history of CDI. The potential impact of CDI on HRQoL and WA impairment requires further evaluation.