. 2024 Dec 5;30(12):2356-2369.

doi: 10.1093/ibd/izae010.

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

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.

PMID: 38366807
PMCID: PMC11630251
DOI: 10.1093/ibd/izae010

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

M Ellen Kuenzig et al. Inflamm Bowel Dis. 2024.

. 2024 Dec 5;30(12):2356-2369.

doi: 10.1093/ibd/izae010.

Authors

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.

PMID: 38366807
PMCID: PMC11630251
DOI: 10.1093/ibd/izae010

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.

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Conflict of interest statement

A.B. has participated in advisory boards for AbbVie, Janssen, Takeda, McKesson, BioJamp, Bristol Myers Squibb; served on the speakers panel for Janssen, Takeda, and AbbVie; and participated in educational activities supported by Viatris, Fresenius Kabi, and Amgen. M.W.C. has received speaker fees from AbbVie. A.R.O. has served on advisory boards for AbbVie Canada, Janssen Canada, and Amgen; has received unrestricted educational grants from AbbVie Canada; and is co-owner of the copyright for PUCAI and the IMPACT questionnaire; and his site is involved with clinical trials for AbbVie, Pfizer, Takeda, Eli Lilly, and BMS. H.S. has served on advisory boards or consulted for Pendopharm, AbbVie Canada, Amgen Canada, Organon Canada, Eli Lilly Canada, Roche Canada, Sandoz Canada, Takeda Canada, Bristol Myers Squibb, and Guardant Health Inc; and has received research funding for an investigator-initiated study from Pfizer. G.G.K. has received honoraria for speaking or consultancy from AbbVie, Amgen, Janssen, Pfizer, Sandoz, and Pendopharm; has received grants for research from Ferring and for educational activities from AbbVie, Bristol Myers Squibb, Ferring, Fresenius Kabi, Janssen, Pfizer, Takeda; and shares ownership of a patent (TREATMENT OF INFLAMMATORY DISORDERS, AUTOIMMUNE DISEASE, AND PBC. UTI Limited Partnership, assignee. Patent WO2019046959A1. PCT/CA2018/051098. 7 Sept. 2018). D.R.M. is co-owner of Biotagenics Inc. K.J. has served on advisory boards for AbbVie Canada, Janssen Canada, Amgen, Merck Canada, Mylan Pharmaceuticals, Viatris, and McKesson Canada; served on the speakers bureau for and received investigator-initiated research support from AbbVie Canada and Janssen Canada; and has stock options for Engene. A.M.G. is past holder of the Northbridge Financial Corporation Chair in Inflammatory Bowel Disease, a joint Hospital-University Chair between the University of Toronto, The Hospital for Sick Children, and the SickKids Foundation; has received research support from AbbVie Canada; is co-owner of copyright for the Pediatric Ulcerative Colitis Activity Index and the TUMMY-UC; has served on the advisory board member or as a consultant for AbbVie, Amgen, Bristol Myers Squibb, Janssen, Lilly, Merck, Pfizer, and Takeda; and has received speaker fees from AbbVie, Janssen, and Takeda. L.E.T. has received research funding from AbbVie Canada, Takeda Canada, Sandoz Canada, Amgen Canada, Gilead Canada, Roche Canada and Pfizer Canada, and has been on Advisory Boards for Janssen Canada, AbbVie Canada, Takeda Canada, Pfizer Canada, Merck Canada, Roche Canada, Sandoz Canada, Organon Canada, Fresenius Kabi Canada, Eli Lilly Canada, and Amgen Canada. G.C.N. has served on the advisory board for AbbVie Canada and Takeda Canada. J.L.J. has received honoraria for speaking and consulting for AbbVie, Janssen, Pfizer, Shire, and Takeda. S.K.M. has participated in advisory board meetings for AbbVie, Janssen, Takeda, Pfizer, Shire and Ferring; and as a speaker at educational events sponsored by Janssen, AbbVie, and Pfizer. C.N.B. is supported by the Bingham Chair in Gastroenterology; has served on advisory Boards for AbbVie Canada, Amgen Canada, Bristol Myers Squibb Canada, Eli Lilly Canada, Ferring Canada, JAMP Pharmaceuticals, Pendopharm Canada, Janssen Canada, Sandoz Canada, Takeda Canada, and Pfizer Canada; has received educational grants from AbbVie Canada, Amgen Canada, Bristol Myers Squibb Canada, Eli Lilly Canada, Organon Canada, Pfizer Canada, Takeda Canada, and Janssen Canada; has served on the speakers panel for AbbVie Canada, Janssen Canada, Pfizer Canada, and Takeda Canada; and has received research funding from AbbVie Canada, Amgen Canada, Pfizer Canada, Sandoz Canada, and Takeda Canada. E.I.B. has served as a consultant for the Dairy Farmers of Ontario and McKesson Canada for matters unrelated to medications used to treat inflammatory bowel disease and for the Canadian Agency for Drugs and Technology in Health. All other authors disclose no conflicts.

Figures

**Figure 1.**
Rate ratios (RRs) comparing the mean number of inflammatory bowel disease (IBD)–specific and IBD-related (A) hospitalizations, (B) emergency department visits, and (C) outpatient visits per year among children and adolescents diagnosed with IBD at <10 years of age (A1a) and between 10 and <16 years of age (A1b). CI, confidence interval.

**Figure 2.**
Hazard ratios (HRs) comparing the age-related risk of intestinal resection or colectomy in children and adolescents with Crohn’s disease and colectomy in children and adolescents with ulcerative colitis. *Models comparing the risk of surgery across age groups did not converge. These provinces are included in the pooled risk of surgery within 5 years of diagnosis but not in the pooled HR. CI, confidence interval.

**Figure 3.**
Rate ratios (RRs) comparing the mean number of healthcare visits (outpatient, emergency department, or hospitalization) with a diagnostic code most likely related to a subsequent inflammatory bowel disease (IBD) diagnosis in the year prior to IBD diagnosis among children and adolescents diagnosed with IBD at <10 years of age (A1a) and between 10 and <16 years of age (A1b). CI, confidence interval.

**Figure 4.**
Odds ratios (ORs) comparing the likelihood of having an inflammatory bowel disease (IBD)–related visit to a gastroenterologist (GI) within 2 and 4 years of IBD diagnosis among children and adolescents diagnosed with IBD at <10 years of age (A1a) and between 10 and <16 years of age (A1b). CI, confidence interval.

**Figure 5.**
The pooled mean (95% confidence interval) number of (A) inflammatory bowel disease (IBD)–specific and (B) IBD-related visits to a gastroenterologist during the first 4 years following IBD diagnosis among children diagnosed with IBD at <10 years of age (A1a; green) and between 10 and <16 years of age (A1b; red). Pooled rate ratios comparing the mean number of visits during the second and fourth years following diagnosis are depicted in black font.

See this image and copyright information in PMC

References

1. Kuenzig ME, Fung SG, Marderfeld L, et al.; InsightScope Pediatric IBD Epidemiology Group. Twenty-first century trends in the global epidemiology of pediatric-onset inflammatory bowel disease: systematic review. Gastroenterology. 2022;162(4):1147-1159.e4. - PubMed
1. Benchimol EI, Bernstein CN, Bitton A, et al.Trends in epidemiology of pediatric inflammatory bowel disease in Canada: distributed network analysis of multiple population-based provincial health administrative databases. Am J Gastroenterol. 2017;112(7):1120-1134. - PMC - PubMed
1. Coward S, Clement F, Benchimol EI, et al.Past and future burden of inflammatory bowel diseases based on modeling of population-based data. Gastroenterology. 2019;156(5):1345-1353.e4. - PubMed
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1. Van Limbergen J, Russell RK, Drummond HE, et al.Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008;135(4):1114-1122. - PubMed

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

Affiliations

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

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Abstract

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Conflict of interest statement

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