Health Confidence Is Associated With Disease Outcomes and Health Care Utilization in Inflammatory Bowel Disease: A Nationwide Cross-sectional Study

Chung Sang Tse, Corey A. Siegel, S. Alandra Weaver, Brant J Oliver, Catherine Bresee, WK (Welmoed) van Deen, Gil Y. Melmed*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)
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Background: We aimed to examine the associations between health confidence (one’s belief on the degree of control on their health and
disease), inflammatory bowel disease (IBD) outcomes, and health care utilization among adults with IBD.
Methods: In total, 17,205 surveys were analyzed from a cross-sectional sample of IBD patients at 23 gastroenterology (GI) practices participating
in the Crohn’s and Colitis Foundations’ IBD Qorus Learning Health System. We used bivariate analyses and multivariable logistic regression to
examine associations between health confidence and disease activity, opioid use, glucocorticoid use, well-being, and health care utilization. We
used receiver operating curve analysis to determine a clinically relevant cutoff for health confidence (0-10 Likert scale).
Results: Health confidence was highly correlated with patients’ well-being, symptomatic disease activity, opioid use, and glucocorticoid use (all
P < .0001). Health confidence scores <8 had 69% sensitivity for emergency department (ED) visits and 66% for hospitalizations. In patients
with inactive disease, patients with low health confidence (<8) were 10 times more likely to call/message the GI office >4 times/month (adjusted
odds ratio [aOR], 10.3; 95% CI, 6.1-17.3; P < .0001), 3-4 times more likely to have an IBD-related ED visit (aOR, 4.0; 95% CI, 2.9, 5.4. P < .0001),
or hospitalization (aOR, 3.0, 95% CI, 2.1, 4.1, P < .0001) compared with patients with high health confidence (≥8).
Conclusions: In a large, national sample of adults with IBD, there were strong associations between patients’ health confidence and multiple
disease outcome measures. Health confidence scores <8 on a 0-10 Likert scale may be clinically useful to screen for patients who are at risk
for ED visits and hospitalizations.
Original languageEnglish
Number of pages8
JournalInflammatory Bowel Diseases
Early online date10 Dec 2021
Publication statusPublished - 10 Dec 2021

Bibliographical note

IBD Qorus is an initiative of the Crohn’s and Colitis
Foundation. IBD Qorus is made possible in part by the
support of AbbVie, AMAG Pharmaceuticals, Eli Lilly,
Helmsley Charitable Trust, Janssen Biotech, Inc., Luitpold
Pharmaceuticals, Inc., Nephroceuticals LLC, Nestle Health
Sciences, Pfizer, Inc., Takeda Pharmaceuticals USA, Inc.,
and UCB/Ferring. Supporters had no involvement in the
design or conduct of the study, collection, management,
analysis or interpretation of the data, preparation, review,
approval of the manuscript, or in the decision to submit
the manuscript for publication. Supporters did not provide direct funding to investigators for any aspect of this


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