Immigrant Status and Work Productivity Loss in Inflammatory Bowel Disease: A Prospective Cohort Study

Abstract Background: Inflammatory bowel disease (IBD) commonly affects individuals during peak working years. Immigrants may face structural and occupational barriers that exacerbate work impairment, but the impact of immigration status on work productivity loss in IBD remains poorly defined. Methods: We analyzed prospectively collected data from adult patients with IBD who completed the Work Productivity and Activity Impairment questionnaire. Immigration status was the primary exposure. The primary outcome was composite work productivity loss derived from absenteeism and presenteeism. Group comparisons used chi-square and Mann–Whitney U tests. Multivariable linear regression was used to evaluate the associations between immigration status and productivity loss, adjusting for demographic, clinical, inflammatory, and psychosocial factors. Weekly productivity losses were monetized using contemporary Ontario wage estimates. Results: Among 244 patients with IBD, immigrants (n=82) experienced significantly greater composite work productivity loss than non-immigrants (median 36.0% vs. 15.0%, p=0.004). Immigrants reported higher absenteeism and presenteeism despite similar inflammatory markers and psychosocial scores. Immigration status remained independently associated with greater productivity loss after multivariable adjustment (β=0.433 SD, p=0.004). Among employed patients, immigrants lost more weekly work hours (17.9 vs. 8.5 hours/week), translating to an additional $345 in weekly lost productivity (> $17,000 annually). Conclusions: Immigrant patients with IBD experience substantially greater work productivity loss independent of disease activity and mental health burden. Immigration status represents a key social determinant of work-related disability in IBD, with significant economic implications.