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Health Services Utilization and Specialist Care in Pediatric Inflammatory Bowel Disease: A Multiprovince Population-Based Cohort Study.
Kuenzig, M Ellen; Bitton, Alain; Carroll, Matthew W; Otley, Anthony R; Singh, Harminder; Kaplan, Gilaad G; Stukel, Therese A; Mack, David R; Jacobson, Kevan; Griffiths, Anne M; El-Matary, Wael; Targownik, Laura E; Nguyen, Geoffrey C; Jones, Jennifer L; Murthy, Sanjay K; Bernstein, Charles N; Lix, Lisa M; Peña-Sánchez, Juan Nicolás; Dummer, Trevor J B; Spruin, Sarah; Fung, Stephen G; Nugent, Zoann; Coward, Stephanie; Cui, Yunsong; Coulombe, Janie; Filliter, Christopher; Benchimol, Eric I.
Affiliation
  • Kuenzig ME; SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
  • Bitton A; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
  • Carroll MW; Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada.
  • Otley AR; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
  • Singh H; Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
  • Kaplan GG; University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
  • Stukel TA; Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
  • Mack DR; Research Institute at CancerCare Manitoba, Winnipeg, MB, Canada.
  • Jacobson K; Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
  • Griffiths AM; ICES, Toronto, ON, Canada.
  • El-Matary W; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
  • Targownik LE; CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada.
  • Nguyen GC; CHEO Research Institute, Ottawa, ON, Canada.
  • Jones JL; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
  • Murthy SK; Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
  • Bernstein CN; SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
  • Lix LM; Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
  • Peña-Sánchez JN; Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
  • Dummer TJB; Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
  • Spruin S; Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Fung SG; ICES, Toronto, ON, Canada.
  • Nugent Z; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
  • Coward S; Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.
  • Cui Y; Department of Medicine, Dalhousie University, Halifax, NS, Canada.
  • Coulombe J; Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  • Filliter C; Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
  • Benchimol EI; Division of Gastroenterology, Ottawa Hospital IBD Centre, Ottawa, ON, Canada.
Inflamm Bowel Dis ; 2024 Feb 16.
Article in En | MEDLINE | ID: mdl-38366807
ABSTRACT

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:

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:

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:

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 disease­related surgeries.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Inflamm Bowel Dis Journal subject: GASTROENTEROLOGIA Year: 2024 Document type: Article Affiliation country: Canada Country of publication: United kingdom
Fulltext
Add to My VHL
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Full text: 1 Collection: 01-internacional Database: MEDLINE Language: En Journal: Inflamm Bowel Dis Journal subject: GASTROENTEROLOGIA Year: 2024 Document type: Article Affiliation country: Canada Country of publication: United kingdom