Inflamm Bowel Dis. 2024 Feb 16:izae010. doi: 10.1093/ibd/izae010. Online ahead of print.

M Ellen Kuenzig ^1 2, Alain Bitton ³, Matthew W Carroll ⁴, Anthony R Otley ⁵, Harminder Singh ^6 7 8, Gilaad G Kaplan ⁹, Therese A Stukel ^10 11, David R Mack ^12 13 14, Kevan Jacobson ¹⁵, Anne M Griffiths ^1 2 16, Wael El-Matary ¹⁷, Laura E Targownik ¹⁸, Geoffrey C Nguyen ^10 11 18, Jennifer L Jones ¹⁹, Sanjay K Murthy ^{20 21 22 23}, Charles N Bernstein ^6 7, Lisa M Lix ²⁴, Juan Nicolás Peña-Sánchez ²⁵, Trevor J B Dummer ²⁶, Sarah Spruin ^10 20, Stephen G Fung ^12 13, Zoann Nugent ⁶, Stephanie Coward ⁹, Yunsong Cui ¹⁹, Janie Coulombe ²⁷, Christopher Filliter ²⁸, Eric I Benchimol ^{1 2 10 11 16}

Author information

¹SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, ON, Canada.

²Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.

³Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada.

⁴Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.

⁵Department of Pediatrics, Dalhousie University, Halifax, NS, Canada.

⁶University of Manitoba IBD Clinical and Research Centre, University of Manitoba, Winnipeg, MB, Canada.

⁷Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada.

⁸Research Institute at CancerCare Manitoba, Winnipeg, MB, Canada.

⁹Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.

¹⁰ICES, Toronto, ON, Canada.

¹¹Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

¹²CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, CHEO, Ottawa, ON, Canada.

¹³CHEO Research Institute, Ottawa, ON, Canada.

¹⁴Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada.

¹⁵Department of Pediatrics, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.

¹⁶Department of Paediatrics, University of Toronto, Toronto, ON, Canada.

¹⁷Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.

¹⁸Mount Sinai Hospital Centre for Inflammatory Bowel Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.

¹⁹Department of Medicine, Dalhousie University, Halifax, NS, Canada.

²⁰Ottawa Hospital Research Institute, Ottawa, ON, Canada.

²¹Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

²²Division of Gastroenterology, Ottawa Hospital IBD Centre, Ottawa, ON, Canada.

²³School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

²⁴Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.

²⁵Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.

²⁶School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.

²⁷Department of Mathematics and Statistics, Université de Montréal, Montréal, QC, Canada.

²⁸Lady 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.