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

M Ellen Kuenzig; Alain Bitton; Matthew W Carroll; Anthony R Otley; Harminder Singh; Gilaad G Kaplan; Therese A Stukel; David R Mack; Kevan Jacobson; Anne M Griffiths; Wael El-Matary; Laura E Targownik; Geoffrey C Nguyen; Jennifer L Jones; Sanjay K Murthy; Charles N Bernstein; Lisa M Lix; Juan Nicolás Peña-Sánchez; Trevor J B Dummer; Sarah Spruin; Stephen G Fung; Zoann Nugent; Stephanie Coward; Yunsong Cui; Janie Coulombe; Christopher Filliter; Eric I Benchimol

doi:10.1093/ibd/izae010

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

Inflamm Bowel Dis. 2024 Dec 5;30(12):2356-2369. doi: 10.1093/ibd/izae010.

Authors

M Ellen Kuenzig^{1

2}, Alain Bitton³, Matthew W Carroll⁴, Anthony R Otley⁵, Harminder Singh^{6

7

8}, Gilaad G Kaplan⁹, Therese A Stukel^{10

11}, David R Mack^{12

13

14}, Kevan Jacobson¹⁵, Anne M Griffiths^{1

2

16}, Wael El-Matary¹⁷, Laura E Targownik¹⁸, Geoffrey C Nguyen^{10

11

18}, Jennifer L Jones¹⁹, Sanjay K Murthy^{20

21

22

23}, Charles N Bernstein^{6

7}, Lisa M Lix²⁴, Juan Nicolás Peña-Sánchez²⁵, Trevor J B Dummer²⁶, Sarah Spruin^{10

20}, Stephen G Fung^{12

13}, Zoann Nugent⁶, Stephanie Coward⁹, Yunsong Cui¹⁹, Janie Coulombe²⁷, Christopher Filliter²⁸, Eric I Benchimol^{1

2

10

11

16}

Affiliations

¹ SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.
² Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.
³ Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada.
⁴ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
⁵ Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.
⁶ University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.
⁷ Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.
⁸ Research Institute at CancerCare Manitoba, Winnipeg, MB, Canada.
⁹ Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
¹⁰ ICES, Toronto, ON, Canada.
¹¹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
¹² CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada.
¹³ CHEO Research Institute, Ottawa, ON, Canada.
¹⁴ Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.
¹⁵ Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.
¹⁶ Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
¹⁷ Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
¹⁸ Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁹ Department of Medicine, Dalhousie University, Halifax, NS, Canada.
²⁰ Ottawa Hospital Research Institute, Ottawa, ON, Canada.
²¹ Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
²² Division of Gastroenterology, Ottawa Hospital IBD Centre, Ottawa, ON, Canada.
²³ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
²⁴ Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
²⁵ Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
²⁶ School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
²⁷ Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada.
²⁸ Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, QC, Canada.

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.

Keywords: Crohn’s disease; distributed network analysis; gastroenterologist care; health administrative data; ulcerative colitis.

Plain language summary

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.

MeSH terms

Adolescent
Canada / epidemiology
Child
Child, Preschool
Colitis, Ulcerative / therapy
Crohn Disease / therapy
Emergency Service, Hospital / statistics & numerical data
Female
Hospitalization* / statistics & numerical data
Humans
Infant
Inflammatory Bowel Diseases / therapy
Male
Patient Acceptance of Health Care* / statistics & numerical data
Proportional Hazards Models
Retrospective Studies

Supplementary concepts

Pediatric Crohn's disease
Pediatric ulcerative colitis

Abstract

Plain language summary

MeSH terms

Supplementary concepts

Grants and funding