Economic burden associated with chronic constipation in Sweden: a retrospective cohort study

Figures & data

Figure 1 Application of inclusion and exclusion criteria for patient selection for chronic constipation identified by type of care contact or laxative use.

Abbreviation: IBS, irritable bowel syndrome.

Table 1 Baseline characteristics, prevalence of comorbidities from 2000 to the end of the analysis period, and mortality in the 12 months after the index date in patients with chronic constipation

Sex and age	Patients n (%)	Parkinson’s disease	Type 2 diabetes mellitus	Multiple sclerosis	Arrhythmia	Spinal injury	Calcium antagonist use	12-month mortality
All patients	4,043 (−)	2.5%	11.4%	1.0%	15.4%	0.3%	14.6%	7.0%
Men
All ages	1,627 (−)	3.1%	15.4%	1.0%	19.1%	0.6%	15.8%	9.2%
18–49 years	216 (13)	0.5%	2.3%	0.9%	1.4%	1.9%	3.7%	1.4%
50–64 years	222 (14)	1.4%	16.2%	5.0%	5.9%	1.8%	11.3%	4.1%
65–74 years	319 (20)	4.1%	19.4%	0.9%	14.1%	0.6%	17.6%	4.1%
≥75 years	870 (53)	3.9%	16.9%	0.1%	28.7%	0.0%	19.3%	14.3%
Women
All ages	2,416 (−)	2.1%	8.7%	1.0%	12.9%	0.1%	13.7%	5.5%
18–49 years	565 (23)	0.2%	2.3%	0.9%	1.6%	0.2%	0.7%	0.0%
50–64 years	388 (16)	1.0%	5.2%	2.3%	4.9%	0.3%	7.0%	1.8%
65–74 years	430 (18)	3.3%	10.9%	0.9%	9.8%	0.0%	15.8%	3.5%
≥75 years	1,033 (43)	3.0%	12.6%	0.7%	23.4%	0.0%	22.6%	10.7%

Table 2 Mean annual number of constipation-related health care and other health care contacts in patients with chronic constipation

Sex and age	Constipation-related health care contacts	All other health care contacts	All health care contacts
Men
All ages	2.5 (5.8)	16.8 (21.5)	19.2 (24.6)
18–49 years	1.9 (2.2)	10.7 (14.4)	12.6 (14.9)
50–64 years	1.9 (1.8)	16.2 (21.8)	18.1 (22.2)
65–74 years	2.4 (5.5)	18.7 (25.7)	21.1 (27.6)
≥75 years	2.8 (7.0)	17.7 (21.0)	20.5 (25.8)
Women
All ages	2.2 (8.5)	14.1 (18.0)	16.3 (23.1)
18–49 years	1.8 (1.1)	12.3 (17.7)	14.0 (17.8)
50–64 years	1.9 (1.6)	13.9 (16.4)	15.8 (16.8)
65–74 years	2.0 (4.5)	16.0 (22.9)	18.0 (26.4)
≥75 years	2.7 (12.5)	14.3 (16.3)	17.0 (25.9)
Overall	2.3 (7.5)	15.2 (19.5)	17.5 (23.7)

Note: Data are expressed as the mean (standard deviation).

Table 3 Annual mean costs in patients with chronic constipation

	Unadjusted			Adjusted for covariates
	Constipation-related costs (€)	Other costs (€)	Total costs (€)	Constipation-related costs (€)	Other costs (€)	Total costs (€)
Men
All ages	2,188 (20,644)	7,647 (19,756)	9,835 (30,379)	1,067 (951–1,199)	5,260 (4,815–5,747)	6,328 (5,850–6,845)
18–49 years	860 (2,589)	4,378 (10,118)	5,238 (10,955)	838 (693–1,014)	5,040 (4,357–5,830)	5,867 (5,157–6,676)
50–64 years	1,488 (5,705)	5,153 (9,237)	6,641 (11,978)	1,172 (960–1,431)	5,165 (4,433–6,017)	6,334 (5,531–7,252)
65–74 years	3,976 (44,527)	7,922 (18,386)	11,898 (49,298)	1,103 (922–1,320)	5,777 (5,037–6,626)	6,874 (6,087–7,763)
≥75 years	2,041 (8,139)	8,992 (23,518)	11,033 (29,591)	1,199 (1,052–1,365)	5,091 (4,608–5,624)	6,278 (5,747–6,858)
Women
All ages	1,274 (8,286)	4,797 (16,997)	6,071 (19,975)	839 (764–922)	3,992 (3,716–4,289)	4,859 (4,559–5,178)
18–49 years	474 (635)	3,027 (6,093)	3,501 (6,235)	659 (557–779)	3,825 (3,365–4,349)	4,505 (4,020–5,048)
50–64 years	974 (3,281)	4,207 (9,992)	5,181 (11,841)	922 (765–1,110)	3,920 (3,399–4,521)	4,863 (4,285–5,518)
65–74 years	789 (2,543)	4,844 (16,513)	5,633 (17,934)	868 (731–1,029)	4,385 (3,848–4,996)	5,278 (4,701–5,925)
≥75 years	2,029 (12,366)	5,970 (22,414)	7,999 (26,822)	942 (835–1,064)	3,864 (3,520–4,240)	4,820 (4,438–5,234)
Overall	1,642 (14,618)	5,944 (18,209)	7,586 (24,760)	951 (929–973)	4,421 (4,339–4,504)	5,388 (5,284–5,494)

Note: Values are per patient and expressed in euros (€) as mean (standard deviation) for unadjusted results and mean (95% confidence interval) for results adjusted for sex, age group, mortality during follow-up, and comorbidities.

Table 4 Regression analysis carried out with constipation-related costs and other costs, using age group, sex, and comorbidities as covariates

Variable	Other costs, proportional cost increase (P-value)	Constipation-related costs, proportional cost increase (P-value)
Men	1.32 (<0.0005)	1.27 (0.001)
Age 50–64 years	1.02 (0.791)	1.40 (0.006)
Age 65–74 years	1.15 (0.125)	1.32 (0.018)
Age ≥75 years	1.01 (0.899)	1.43 (0.0005)
Died during follow-up	7.76 (<0.0005)	12.67 (<0.0005)
Parkinson’s disease	1.34 (0.085)	1.26 (0.297)
Type 2 diabetes mellitus	1.26 (0.007)	1.27 (0.033)
Multiple sclerosis	1.48 (0.138)	2.21 (0.022)
Arrhythmia	1.50 (<0.0005)	1.31 (0.008)
Spinal injury	0.83 (0.705)	1.11 (0.867)
Calcium antagonist use	1.04 (0.594)	1.15 (0.168)

Notes: In order to estimate costs, coefficients were back-transformed through exponentiation. The exp (intercept) corresponds to the average annual cost of chronic constipation for a baseline individual, in this case a female aged between 18 and 49 years who was alive at end of follow-up and did not have any of the comorbidities.

Table 5 Annual unadjusted laxative and nonlaxative costs

Sex and age	Laxative costs (€)	Other drug costs (€)
Men
All ages	63 (79)	713 (1,296)
18–49 years	56 (80)	531 (1,247)
50–64 years	60 (98)	819 (2,264)
65–74 years	65 (76)	926 (1,491)
≥75 years	64 (73)	653 (782)
Women
All ages	60 (71)	563 (1,013)
18–49 years	54 (90)	443 (1,237)
50–64 years	58 (66)	696 (1,598)
65–74 years	61 (60)	619 (658)
≥75 years	63 (63)	556 (641)
Total	61 (74)	624 (1,138)

Note: All values are expressed as annual mean (standard deviation) costs per patient.