Inflammatory Bowel Diseases
Volume 22, Issue 10, 2016, Pages 2482-2490

Health Services Utilization, Specialist Care, and Time to Diagnosis with Inflammatory Bowel Disease in Immigrants to Ontario, Canada: A Population-Based Cohort Study (Article) (Open Access)

Benchimol E.I.* , Manuel D.G. , Mojaverian N. , Mack D.R. , Nguyen G.C. , To T. , Guttmann A.
  • a Children's Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada, School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • b School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Ottawa Hospital Research Institute, Ottawa, ON, Canada, Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
  • c Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
  • d Children's Hospital of Eastern Ontario IBD Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada, Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
  • e Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Mount Sinai Centre for Inflammatory Bowel Disease, Mount Sinai Hospital, Toronto, ON, Canada, Department of Medicine, University of Toronto, Toronto, ON, Canada
  • f Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
  • g Institute for Clinical Evaluative Sciences, Toronto, ON, Canada, Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, ON, Canada, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada, Department of Paediatrics, University of Toronto, Toronto, ON, Canada

Abstract

Background: Canada has amongst the highest incidence of inflammatory bowel disease (IBD) in the world, and the highest proportion of immigrants among G8 nations. We determined differences in prediagnosis delay, specialist care, health services use, and risk of surgery in immigrants with IBD. Methods: All incident cases of IBD in children (1994-2009) and adults (1999-2009) were identified from population-based health administrative data in Ontario, Canada. Linked immigration data identified those who arrived to Ontario after 1985. We compared time to diagnosis, postdiagnosis health services use (IBD specific and related), physician specialist care in immigrants and nonimmigrants, and risk of surgery between immigrants and nonimmigrants. Results: Thousand two hundred two immigrants were compared with 22,990 nonimmigrants. Immigrants had similar time to diagnosis as nonimmigrants for Crohn's (hazard ratio [HR] 1.002; 95% confidence intervals [CIs] 0.89-1.12) and ulcerative colitis (HR 1.073; 95% CI 0.95-1.21). For outpatient visits, immigrants with IBD were seen by gastroenterologists more often than nonimmigrants. Immigrants had greater IBD-specific outpatient health services use after diagnosis (odds ratio 1.24; 95% CI 1.15-1.33), emergency department visits (odds ratio 1.57, 95% CI 1.30-1.91), and hospitalizations (odds ratio 1.19; 95% CI 1.02-1.40). In immigrants, there was lower risk of surgery for Crohn's (HR 0.66, 95% CI 0.43-0.99) and ulcerative colitis (HR 0.52, 95% CI 0.31-0.87). Conclusions: Immigrants to Canada had greater outpatient and specialty care and lower risk of surgery, with no delay in diagnosis, indicating appropriate use of the health system. Copyright © 2016 Crohn's & Colitis Foundation of America, Inc.

Author Keywords

immigrants Inflammatory bowel disease Health Administrative Data Epidemiology Health services research

Index Keywords

descriptive research patient care immigrant hospitalization human Cohort Studies middle aged statistics and numerical data time factor priority journal gastroenterology Time Factors outpatient care Humans migrant male Emigrants and Immigrants female Incidence Article health care utilization Ontario Inflammatory Bowel Diseases inflammatory bowel disease adult major clinical study medical specialist ambulatory care patient attitude cohort analysis Patient Acceptance of Health Care time to diagnosis colon resection intestine resection specialist care surgical risk time
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84988646218&doi=10.1097%2fMIB.0000000000000905&partnerID=40&md5=eeae712dff4c52a95b2507676f0832f6
DOI: 10.1097/MIB.0000000000000905
ISSN: 10780998
Cited by: 6
Original Language: English