Health Services Utilization and Specialist Care in Pediatric Inflammatory Bowel Disease: A Multiprovince
M Ellen Kuenzig1,2, Alain Bitton3, Matthew W Carroll4
1SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
Insights
Children diagnosed with inflammatory bowel disease (IBD) younger than 10 years had fewer emergency visits and Crohn’s-related surgeries. Overall health services utilization for pediatric IBD patients showed similar patterns across age groups.
Area of Science:
- Pediatric Gastroenterology
- Health Services Research
- Epidemiology
Background:
- Rising incidence of pediatric inflammatory bowel disease (IBD) necessitates understanding health service utilization patterns.
- Comparing health services utilization and surgical needs between younger (<10 years) and older (10-<16 years) children diagnosed with IBD is crucial.
Purpose of the Study:
- To compare health services utilization and surgical outcomes in children diagnosed with IBD at different early ages.
- To identify potential age-related differences in healthcare needs for pediatric IBD patients.
Main Methods:
- Retrospective cohort study using linked health administrative data from five Canadian provinces.
- Compared outpatient visits, emergency department visits, and hospitalizations using negative binomial regression.
- Assessed surgery risk with Cox proportional hazards models, adjusting for demographic factors and pooling province-specific estimates via meta-analysis.
Main Results:
- No significant age differences were observed in hospitalization or outpatient visit frequencies.
- Children diagnosed younger (<10 years) had fewer emergency department visits (RR, 0.70; 95% CI, 0.50-0.97).
- Younger diagnosed children were less likely to require Crohn's-related surgery (HR, 0.49; 95% CI, 0.26-0.92), while colectomy risk was similar for ulcerative colitis.
Conclusions:
- Health services utilization patterns for pediatric inflammatory bowel disease are largely similar across different early age diagnoses.
- Younger children diagnosed with IBD (<10 years) may have a lower risk of emergency visits and Crohn's-related surgeries compared to older children (10-<16 years).
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.
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