Health Services Utilization and Specialist Care in Pediatric Inflammatory Bowel Disease: A Multiprovince Population-Based Cohort Study.

Crohn’s disease distributed network analysis gastroenterologist care health administrative data ulcerative colitis

Journal

Inflammatory bowel diseases
ISSN: 1536-4844
Titre abrégé: Inflamm Bowel Dis
Pays: England
ID NLM: 9508162

Informations de publication

Date de publication:
16 Feb 2024
Historique:
received: 26 10 2023
medline: 17 2 2024
pubmed: 17 2 2024
entrez: 17 2 2024
Statut: aheadofprint

Résumé

Patterns of health services utilization among children with inflammatory bowel disease (IBD) are important to understand as the number of children with IBD continues to increase. We compared health services utilization and surgery among children diagnosed <10 years of age (Paris classification: A1a) and between 10 and <16 years of age (A1b). Incident cases of IBD diagnosed <16 years of age were identified using validated algorithms from deterministically linked health administrative data in 5 Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec) to conduct a retrospective cohort study. We compared the frequency of IBD-specific outpatient visits, emergency department visits, and hospitalizations across age groups (A1a vs A1b [reference]) using negative binomial regression. The risk of surgery was compared across age groups using Cox proportional hazards models. Models were adjusted for sex, rural/urban residence location, and mean neighborhood income quintile. Province-specific estimates were pooled using random-effects meta-analysis. Among the 1165 (65.7% Crohn's) children with IBD included in our study, there were no age differences in the frequency of hospitalizations (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.74-1.06) or outpatient visits (RR, 0.95; 95% CI, 0.78-1.16). A1a children had fewer emergency department visits (RR, 0.70; 95% CI, 0.50-0.97) and were less likely to require a Crohn's-related surgery (hazard ratio, 0.49; 95% CI, 0.26-0.92). The risk of colectomy was similar among children with ulcerative colitis in both age groups (hazard ratio, 0.71; 95% CI, 0.49-1.01). Patterns of health services utilization are generally similar when comparing children diagnosed across age groups. Among 1165 children with inflammatory bowel disease, health services utilization was similar for children diagnosed <10 years of age and those diagnosed ≥10 years of age, except younger children had fewer emergency department visits and Crohn’s disease–related surgeries.

Sections du résumé

BACKGROUND BACKGROUND
Patterns of health services utilization among children with inflammatory bowel disease (IBD) are important to understand as the number of children with IBD continues to increase. We compared health services utilization and surgery among children diagnosed <10 years of age (Paris classification: A1a) and between 10 and <16 years of age (A1b).
METHODS METHODS
Incident cases of IBD diagnosed <16 years of age were identified using validated algorithms from deterministically linked health administrative data in 5 Canadian provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec) to conduct a retrospective cohort study. We compared the frequency of IBD-specific outpatient visits, emergency department visits, and hospitalizations across age groups (A1a vs A1b [reference]) using negative binomial regression. The risk of surgery was compared across age groups using Cox proportional hazards models. Models were adjusted for sex, rural/urban residence location, and mean neighborhood income quintile. Province-specific estimates were pooled using random-effects meta-analysis.
RESULTS RESULTS
Among the 1165 (65.7% Crohn's) children with IBD included in our study, there were no age differences in the frequency of hospitalizations (rate ratio [RR], 0.88; 95% confidence interval [CI], 0.74-1.06) or outpatient visits (RR, 0.95; 95% CI, 0.78-1.16). A1a children had fewer emergency department visits (RR, 0.70; 95% CI, 0.50-0.97) and were less likely to require a Crohn's-related surgery (hazard ratio, 0.49; 95% CI, 0.26-0.92). The risk of colectomy was similar among children with ulcerative colitis in both age groups (hazard ratio, 0.71; 95% CI, 0.49-1.01).
CONCLUSIONS CONCLUSIONS
Patterns of health services utilization are generally similar when comparing children diagnosed across age groups.
Among 1165 children with inflammatory bowel disease, health services utilization was similar for children diagnosed <10 years of age and those diagnosed ≥10 years of age, except younger children had fewer emergency department visits and Crohn’s disease–related surgeries.

Autres résumés

Type: plain-language-summary (eng)
Among 1165 children with inflammatory bowel disease, health services utilization was similar for children diagnosed <10 years of age and those diagnosed ≥10 years of age, except younger children had fewer emergency department visits and Crohn’s disease–related surgeries.

Identifiants

DOI: 10.1093/ibd/izae010 PMID: 38366807
pubmed: 38366807
pii: 7609360
doi: 10.1093/ibd/izae010
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Subventions

Organisme : CIHR
ID : PJT-162393
Pays : Canada

Informations de copyright

© 2024 Crohn’s & Colitis Foundation. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation.

Auteurs

M Ellen Kuenzig (ME)

SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
ORCID: 0000-0002-3984-8426

Alain Bitton (A)

Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada.

Matthew W Carroll (MW)

Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

Anthony R Otley (AR)

Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.

Harminder Singh (H)

University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
Research Institute at CancerCare Manitoba, Winnipeg, MB, Canada.
ORCID: 0000-0002-9354-2356

Gilaad G Kaplan (GG)

Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
ORCID: 0000-0003-2719-0556

Therese A Stukel (TA)

ICES, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

David R Mack (DR)

CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada.
CHEO Research Institute, Ottawa, ON, Canada.
Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.

Kevan Jacobson (K)

Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
ORCID: 0000-0001-7269-8557

Anne M Griffiths (AM)

SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

Wael El-Matary (W)

Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
ORCID: 0000-0001-6417-7583

Laura E Targownik (LE)

Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Geoffrey C Nguyen (GC)

ICES, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Jennifer L Jones (JL)

Department of Medicine, Dalhousie University, Halifax, NS, Canada.

Sanjay K Murthy (SK)

Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
Division of Gastroenterology, Ottawa Hospital IBD Centre, Ottawa, ON, Canada.
School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

Charles N Bernstein (CN)

University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.

Lisa M Lix (LM)

Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

Juan Nicolás Peña-Sánchez (JN)

Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

Trevor J B Dummer (TJB)

School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

Sarah Spruin (S)

ICES, Toronto, ON, Canada.
Ottawa Hospital Research Institute, Ottawa, ON, Canada.

Stephen G Fung (SG)

CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada.
CHEO Research Institute, Ottawa, ON, Canada.

Zoann Nugent (Z)

University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.

Stephanie Coward (S)

Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
ORCID: 0000-0003-0675-7226

Yunsong Cui (Y)

Department of Medicine, Dalhousie University, Halifax, NS, Canada.

Janie Coulombe (J)

Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada.

Christopher Filliter (C)

Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, QC, Canada.

Eric I Benchimol (EI)

SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
ORCID: 0000-0001-8855-3598

Classifications MeSH