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Travel Time to Treating Center Is Associated With Diagnostic Delay in Pediatric Inflammatory Bowel Disease
Joi F McLaughlin1, Tiffany Linville2, Traci W Jester3
1Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Insights
Delayed diagnosis of pediatric inflammatory bowel disease (IBD) is longer for Crohn's disease than ulcerative colitis. Diagnostic times were equitable across racial and ethnic groups, but longer travel times impacted care.
Area of Science:
- Pediatric gastroenterology
- Inflammatory Bowel Disease (IBD) research
- Health equity in diagnostics
Background:
- Delayed diagnosis of pediatric inflammatory bowel disease (IBD) is linked to prolonged symptoms and poorer long-term health outcomes.
- Understanding factors contributing to diagnostic delays is crucial for improving patient care and outcomes.
Purpose of the Study:
- To evaluate the association between race, ethnicity, disease type, and social factors with delayed diagnosis in pediatric IBD.
- To identify key determinants of diagnostic delay in children with IBD.
Main Methods:
- A cross-sectional study involving 869 newly diagnosed pediatric IBD patients across 22 US sites (2019-2022).
- Data collection included parent/guardian-reported race, ethnicity, time to diagnosis, and social determinants of health.
- Bivariate and multivariable analyses were used to assess associations with diagnostic delay categories.
Main Results:
- The mean time to diagnosis was 265.9 days. Crohn's disease (CD) diagnosis took longer than ulcerative colitis (UC).
- Factors associated with longer diagnostic delays included CD versus UC, presence of multiple comorbidities, and extended travel times to clinics.
- No significant associations were found between diagnostic delay and race, ethnicity, gender, parental education, income, insurance, health literacy, or health system distrust.
Conclusions:
- Diagnostic delay for pediatric IBD is longer in Crohn's disease compared to ulcerative colitis.
- Importantly, diagnostic timelines were found to be equitable across different racial and ethnic groups.
- New diagnostic care models are necessary to address delays, particularly for populations facing challenges with extended travel distances.
Background & Aims:
Delayed diagnosis of inflammatory bowel disease (IBD) leads to prolonged symptoms and worse long-term outcomes. We sought to evaluate whether race, ethnicity, disease type, and social factors are associated with delayed diagnosis of pediatric IBD.
Methods:
We performed a cross-sectional study of newly diagnosed pediatric patients with IBD at 22 United States sites from 2019 to 2022. Parents/guardians reported race, ethnicity, time between symptom onset and diagnosis, and other social determinants of health. Through bivariate and multivariable analyses using generalized estimating equations, we evaluated associations between these factors and diagnosis time defined as ≤60 days, 61 to 180 days, 181 to 365 days, and >365 days.
Results:
We enrolled 869 participants (mean age at diagnosis, 13.1 years; 52% male; 57% Crohn's disease [CD]; 34% ulcerative colitis [UC]; 8% Hispanic; 30% non-White). Overall, the mean time to diagnosis was 265.9 days. After adjustment, factors associated with longer diagnosis time included CD vs UC (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.9-3.5), 2 or more other health conditions (OR, 1.7; 95% CI, 1.1-2.7), and longer travel time to clinic (>1 hour [OR, 1.7; 95% CI, 1.2-2.4], >2 hours (OR, 1.8; 95% CI, 1.2-2.9] each vs <30 minutes). There was no association with race, ethnicity, birth country, gender, parent education, household income, insurance type, health literacy, and health system distrust.
Conclusions:
Consistent with prior literature, diagnostic delay is longer for CD than UC. Reassuringly, time to diagnosis is equitable across racioethnic groups. New models of diagnostic care are needed for communities affected by longer travel times.
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